Provider Demographics
NPI:1003115908
Name:RUSSO CHIROPRACTIC,P.C.
Entity Type:Organization
Organization Name:RUSSO CHIROPRACTIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-567-4437
Mailing Address - Street 1:1300 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1339
Mailing Address - Country:US
Mailing Address - Phone:631-567-4437
Mailing Address - Fax:631-567-3018
Practice Address - Street 1:1300 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1339
Practice Address - Country:US
Practice Address - Phone:631-567-4437
Practice Address - Fax:631-567-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty