Provider Demographics
NPI:1477888014
Name:RUSSELL CHIROPRACTIC & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:RUSSELL CHIROPRACTIC & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWANDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-726-0888
Mailing Address - Street 1:741 N. COUNTRY CLUB DR.
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:FL
Mailing Address - Zip Code:34429-5405
Mailing Address - Country:US
Mailing Address - Phone:352-726-0888
Mailing Address - Fax:352-726-5504
Practice Address - Street 1:2800 W. GULF TO LAKE HWY.
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9205
Practice Address - Country:US
Practice Address - Phone:352-726-0888
Practice Address - Fax:352-726-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382206100Medicaid
FL1295717072OtherNPI- RUSSELL LEWANDOWSKI D.C.
FL382206100Medicaid