Provider Demographics
NPI:1619151644
Name:DELAINO, RUSSELL EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:EDWIN
Last Name:DELAINO
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 1:4 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2400
Mailing Address - Country:US
Mailing Address - Phone:706-233-9181
Mailing Address - Fax:706-233-9181
Practice Address - Street 1:4 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2400
Practice Address - Country:US
Practice Address - Phone:706-233-9181
Practice Address - Fax:706-233-9181
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor