Physician Compare National (NPI:1487961322)

HEALTHCARE PROVIDER: TY D RUSSELL D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1487961322
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143118026
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110714000601
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RUSSELL
	Individual professional last name
Provider First Name	TY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	207 ATLANTA ST SE
	Group Practice or individual's line 1 address
City	GRAVETTE
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	727369364
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y