MEDICARE: RUSSELL J. FLACCO DC

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	DC001396L	PA

General Provider Information

NPI Number	:	1871606111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL J. FLACCO DC

Provider Business Mailing Address
First Line	:	252 W SWAMP RD
Second Line	:	UNIT 57
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-2465
Country	:	US
Telephone Number	:	215-348-9551
Fax Number	:	215-345-9078

Provider Business Practice Location Address
First Line	:	252 W SWAMP RD
Second Line	:	UNIT 57
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-2465
Country	:	US
Telephone Number	:	215-348-9551
Fax Number	:	215-345-9078

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	06/25/2008

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Directions to “ RUSSELL J. FLACCO DC” Practice Location

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