Provider Demographics
NPI:1356856207
Name:SPINAL HEALTH RECOVERY RUSSO CHIROPRACTICE CORP
Entity Type:Organization
Organization Name:SPINAL HEALTH RECOVERY RUSSO CHIROPRACTICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PRITI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-210-0509
Mailing Address - Street 1:8950 CAL CENTER DR STE 160165
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3259
Mailing Address - Country:US
Mailing Address - Phone:732-210-0509
Mailing Address - Fax:732-542-1948
Practice Address - Street 1:8950 CAL CENTER DR STE 160165
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3259
Practice Address - Country:US
Practice Address - Phone:732-210-0509
Practice Address - Fax:732-542-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty