Provider Demographics
NPI:1598945305
Name:RUSSELL, TODD DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DAVID
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 1:520 N BROOKHURST ST
Mailing Address - Street 2:123
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5227
Mailing Address - Country:US
Mailing Address - Phone:714-776-2727
Mailing Address - Fax:
Practice Address - Street 1:520 N BROOKHURST ST
Practice Address - Street 2:123
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5227
Practice Address - Country:US
Practice Address - Phone:714-776-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20377111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic