Provider Demographics
NPI:1376705855
Name:RUSSELL G WARR DC A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:RUSSELL G WARR DC A CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:GEZA
Authorized Official - Last Name:WARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-998-5273
Mailing Address - Street 1:7012 RESEDA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4275
Mailing Address - Country:US
Mailing Address - Phone:818-998-5273
Mailing Address - Fax:818-998-5337
Practice Address - Street 1:7012 RESEDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4275
Practice Address - Country:US
Practice Address - Phone:818-998-5273
Practice Address - Fax:818-998-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty