MEDICARE: DR. ROSE DELAINE RUSSELL 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	DC36269	CA

General Provider Information

NPI Number	:	1972292589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSE DELAINE RUSSELL DC

Provider Business Mailing Address
First Line	:	1726 BUENA VISTA AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-1269
Country	:	US
Telephone Number	:	510-499-7859
Fax Number	:

Provider Business Practice Location Address
First Line	:	5335 COLLEGE AVE STE 25
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-2804
Country	:	US
Telephone Number	:	510-499-7859
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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