MEDICARE: DR. MICHAEL J RUSSAMANO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104555800	VA

General Provider Information

NPI Number	:	1437192432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J RUSSAMANO D.C.

Provider Business Mailing Address
First Line	:	1410 INCARNATION DR
Second Line	:	SUITE 204
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-5708
Country	:	US
Telephone Number	:	434-817-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 INCARNATION DR
Second Line	:	SUITE 204
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-5708
Country	:	US
Telephone Number	:	434-817-7788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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