MEDICARE: DR. ROBB RUSSELL 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	14749	CA

General Provider Information

NPI Number	:	1962587493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBB RUSSELL D.C.

Provider Business Mailing Address
First Line	:	3332 KALLIN AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4207
Country	:	US
Telephone Number	:	562-421-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 E WILLOW ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2310
Country	:	US
Telephone Number	:	562-424-4976
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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