Provider Demographics
NPI:1174653356
Name:RUSSAK, AARON WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:WALTER
Last Name:RUSSAK
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 1:21 MABRY PL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2731
Mailing Address - Country:US
Mailing Address - Phone:423-432-9511
Mailing Address - Fax:
Practice Address - Street 1:1409 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-4420
Practice Address - Country:US
Practice Address - Phone:423-757-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor