Provider Demographics
NPI:1619757036
Name:HASELEY, RUSSELL SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:SHAWN
Last Name:HASELEY
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 1:468 DELAWARE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1335
Mailing Address - Country:US
Mailing Address - Phone:716-847-1200
Mailing Address - Fax:716-847-1212
Practice Address - Street 1:468 DELAWARE AVE FL 3
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1335
Practice Address - Country:US
Practice Address - Phone:716-847-1200
Practice Address - Fax:716-847-1212
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor