Healthcare Provider Details

I. General information

NPI: 1487514055
Provider Name (Legal Business Name): ALISHA RUSS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FOXGLOVE TRL
FAIRVIEW TX
75069-6878
US

IV. Provider business mailing address

PO BOX 262181
PLANO TX
75026-2181
US

V. Phone/Fax

Practice location:
  • Phone: 727-742-7358
  • Fax: 972-208-0419
Mailing address:
  • Phone: 727-742-7358
  • Fax: 972-208-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number11831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: