Provider Demographics
NPI:1073581120
Name:RUSSELL, TROY D (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:D
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MALL RING CIRCLE
Mailing Address - Street 2:#205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:702-990-2225
Mailing Address - Fax:702-990-7711
Practice Address - Street 1:715 MALL RING CIRCLE
Practice Address - Street 2:#205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-990-2225
Practice Address - Fax:702-990-7711
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98113Medicare UPIN
NV38283Medicare ID - Type Unspecified