Provider Demographics
NPI:1548428576
Name:DRUSSEL CHIROPRACTIC AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:DRUSSEL CHIROPRACTIC AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRUSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-375-2420
Mailing Address - Street 1:777 N 500 W
Mailing Address - Street 2:STE 205
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1541
Mailing Address - Country:US
Mailing Address - Phone:801-375-2420
Mailing Address - Fax:801-374-8588
Practice Address - Street 1:777 N 500 W
Practice Address - Street 2:STE 205
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1541
Practice Address - Country:US
Practice Address - Phone:801-375-2420
Practice Address - Fax:801-374-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT68564891202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty