Provider Demographics
NPI:1538129341
Name:RUSSELL, TOBY H (DC)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:H
Last Name:RUSSELL
Suffix:
Gender:M
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:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-0381
Mailing Address - Country:US
Mailing Address - Phone:865-435-4217
Mailing Address - Fax:865-435-4299
Practice Address - Street 1:1116 E TRI COUNTY BLVD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-6224
Practice Address - Country:US
Practice Address - Phone:865-435-4217
Practice Address - Fax:865-435-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3972687Medicare PIN
TNU91125Medicare UPIN