Provider Demographics
NPI:1437107372
Name:BLACKWELL, RUSSELL DELL (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DELL
Last Name:BLACKWELL
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 1:211 W SEALY ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2340
Mailing Address - Country:US
Mailing Address - Phone:281-585-3500
Mailing Address - Fax:281-585-3505
Practice Address - Street 1:211 W SEALY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2340
Practice Address - Country:US
Practice Address - Phone:281-585-3500
Practice Address - Fax:281-585-3505
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor