Provider Demographics
NPI:1366651986
Name:SEAGAL, RUSSELL D (DC)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:D
Last Name:SEAGAL
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 1:26733 OAK GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1434
Mailing Address - Country:US
Mailing Address - Phone:818-681-4889
Mailing Address - Fax:
Practice Address - Street 1:801 S FLOWER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4625
Practice Address - Country:US
Practice Address - Phone:213-481-7026
Practice Address - Fax:213-623-9985
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19979111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician