Provider Demographics
NPI:1518516087
Name:RUSSELL FAMILY ACUPUNCTURE, INC
Entity Type:Organization
Organization Name:RUSSELL FAMILY ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:707-773-3375
Mailing Address - Street 1:210 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4199
Mailing Address - Country:US
Mailing Address - Phone:707-773-3375
Mailing Address - Fax:707-646-4342
Practice Address - Street 1:210 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4199
Practice Address - Country:US
Practice Address - Phone:707-773-3375
Practice Address - Fax:707-646-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service