Provider Demographics
NPI:1558945113
Name:RUSSELL, ALEC TAYLER (DC, MSFN)
Entity Type:Individual
Prefix:DR
First Name:ALEC
Middle Name:TAYLER
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DC, MSFN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 W 3600 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3893
Mailing Address - Country:US
Mailing Address - Phone:801-972-1222
Mailing Address - Fax:
Practice Address - Street 1:1878 W 3600 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3893
Practice Address - Country:US
Practice Address - Phone:801-972-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12238316-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor