Provider Demographics
NPI:1477696649
Name:RUSSELL, JEANNE KERN (DC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:KERN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602
Mailing Address - Country:US
Mailing Address - Phone:818-760-2059
Mailing Address - Fax:818-760-2063
Practice Address - Street 1:10912 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602
Practice Address - Country:US
Practice Address - Phone:818-760-2059
Practice Address - Fax:818-760-2063
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI144111N00000X
CA12269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor