Provider Demographics
NPI:1093047391
Name:WOUTERS, RUSSELL DADE (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DADE
Last Name:WOUTERS
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 1:700 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3975
Mailing Address - Country:US
Mailing Address - Phone:970-249-4213
Mailing Address - Fax:
Practice Address - Street 1:700 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3975
Practice Address - Country:US
Practice Address - Phone:970-249-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCH6661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor