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General NPI Number Information
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NPI Number | 1265782296
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Entity Type | Organization
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Legal Business Name | RUSS TANNENBAUM DC PA
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 4974 W ATLANTIC BLVD
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City | MARGATE
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State | FL
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Zip | 33063-5300
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Country | US
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Telephone | 954-968-8400
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Fax | 954-388-5937
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Provider Business Mailing Address
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Address Line | 5800 COLONIAL DRIVE STE 305
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City | MARGATE
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State | FL
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Zip | 33063
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Country | US
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Telephone | 954-993-4058
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Fax | 954-916-5198
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Authorized Official
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Title or Position | BILLER
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Name | MS. MARY HAWKS
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Credential |
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Telephone | 954-993-4058
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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 | CH4086
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License Number State | FL
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