Provider Demographics
NPI:1437625365
Name:RUSSELL CHIROPRACTIC AND SPORTS THERAPY PA
Entity Type:Organization
Organization Name:RUSSELL CHIROPRACTIC AND SPORTS THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GALLION
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-483-5356
Mailing Address - Street 1:138 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-1905
Mailing Address - Country:US
Mailing Address - Phone:785-483-5356
Mailing Address - Fax:785-483-3535
Practice Address - Street 1:138 W 7TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-1905
Practice Address - Country:US
Practice Address - Phone:785-483-5356
Practice Address - Fax:785-483-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1699100685OtherNPI
KS1699100685OtherNPI