Provider Demographics
NPI:1275600256
Name:CAMPANELLA, RUSSELL S (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:S
Last Name:CAMPANELLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3313 CHILI AVE
Mailing Address - Street 2:STE D
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5300
Mailing Address - Country:US
Mailing Address - Phone:585-334-4060
Mailing Address - Fax:585-321-1329
Practice Address - Street 1:4138 W HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5224
Practice Address - Country:US
Practice Address - Phone:585-334-4060
Practice Address - Fax:585-321-1329
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU73927Medicare UPIN
NYBB3894Medicare ID - Type Unspecified