Provider Demographics
NPI:1215030309
Name:LALONDE, RUSSELL JOHN (DC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:JOHN
Last Name:LALONDE
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 1:13652 TEN MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178
Mailing Address - Country:US
Mailing Address - Phone:248-437-8184
Mailing Address - Fax:248-437-8185
Practice Address - Street 1:13652 TEN MILE ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178
Practice Address - Country:US
Practice Address - Phone:248-437-8184
Practice Address - Fax:248-437-8185
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH630005OtherMCARE
OF35233Medicare ID - Type Unspecified
CH630005OtherMCARE