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General NPI Number Information
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NPI Number | 1720193279
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Entity Type | Organization
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Legal Business Name | DR ANN MARIE RUSSELL, CHIROPRACTOR, SC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 498 W BOUGHTON RD SUITE 102
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1893
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Country | US
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Telephone | 630-759-4949
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Fax | 630-759-1049
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Provider Business Mailing Address
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Address Line | 498 W BOUGHTON RD SUITE 102
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1893
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Country | US
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Telephone | 630-759-4949
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Fax | 630-759-1049
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANN MARIE F RUSSELL
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Credential | D.C.
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Telephone | 630-759-4949
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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 |
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License Number State |
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