Provider Demographics
NPI:1528003340
Name:RUSSAMANO CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:RUSSAMANO CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSAMANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-817-7788
Mailing Address - Street 1:3330 NAZARETH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2018
Mailing Address - Country:US
Mailing Address - Phone:610-252-3449
Mailing Address - Fax:
Practice Address - Street 1:3330 NAZARETH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2018
Practice Address - Country:US
Practice Address - Phone:610-252-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty