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General NPI Number Information
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NPI Number | 1174291975
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Entity Type | Individual
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Provider Name | KATHRYN A RUSSELL DC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2021
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Last Update Date | 06/18/2023
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Provider Practice Location Address
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Address Line | 350 JOHN SIMS PKWY W UNIT 401
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City | NICEVILLE
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State | FL
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Zip | 32578-1963
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Country | US
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Telephone | 850-678-8049
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Fax |
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Provider Business Mailing Address
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Address Line | 460 S ROSEMARY AVE APT 307
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5799
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Country | US
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Telephone | 850-226-3911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 13696
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License Number State | FL
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