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General NPI Number Information
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NPI Number | 1629151402
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Entity Type | Individual
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Provider Name | RUSSELL MARTIN MACDONALD DC
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 12310 N DIVISION 105
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City | SPOKANE
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State | WA
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Zip | 99218
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Country | US
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Telephone | 509-466-1117
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Fax | 509-464-0578
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Provider Business Mailing Address
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Address Line | 12310 N DIVISION 105
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City | SPOKANE
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State | WA
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Zip | 99218
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Country | US
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Telephone | 509-466-1117
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Fax | 509-464-0578
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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 | CH33968
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License Number State | WA
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