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General NPI Number Information
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NPI Number | 1609963867
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Entity Type | Organization
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Legal Business Name | RUSSELL CHIROPRACTIC, INC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 905 G ST SUITE G
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City | MARYSVILLE
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State | CA
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Zip | 95901-5121
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Country | US
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Telephone | 530-749-2225
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Fax | 530-479-2229
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Provider Business Mailing Address
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Address Line | 905 G ST SUITE G
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City | MARYSVILLE
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State | CA
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Zip | 95901-5121
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Country | US
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Telephone | 530-749-2225
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Fax | 530-479-2229
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAIG STEVEN RUSSELL
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Credential | D.C.
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Telephone | 530-749-2225
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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 | DC26585
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License Number State | CA
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