Provider Demographics
NPI:1356443030
Name:RUSSO, JOSEPH A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:RUSSO
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 1:1605 LOCUST HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6075
Mailing Address - Country:US
Mailing Address - Phone:864-848-4992
Mailing Address - Fax:864-848-4997
Practice Address - Street 1:1605 LOCUST HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6075
Practice Address - Country:US
Practice Address - Phone:864-848-4992
Practice Address - Fax:864-848-4997
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor