MEDICARE: DR. RUSSELL WILLIAM BLOXTON 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	23747	CA
2	111N00000X	Chiropractor	DC23747	CA

General Provider Information

NPI Number	:	1952306953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL WILLIAM BLOXTON D.C.

Provider Business Mailing Address
First Line	:	161 THUNDER DR
Second Line	:	STE 209
City	:	VISTA
State	:	CA
Zip	:	92083-6052
Country	:	US
Telephone Number	:	760-941-3132
Fax Number	:	760-687-7441

Provider Business Practice Location Address
First Line	:	161 THUNDER DR
Second Line	:	STE 209
City	:	VISTA
State	:	CA
Zip	:	92083-6052
Country	:	US
Telephone Number	:	760-941-3132
Fax Number	:	760-687-7441

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/14/2020

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