Provider Demographics
NPI:1659547685
Name:FERRELL, RUSSELL NORMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:NORMAN
Last Name:FERRELL
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 1:3137 LORNA RD STE 5
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5454
Mailing Address - Country:US
Mailing Address - Phone:205-823-7606
Mailing Address - Fax:
Practice Address - Street 1:3137 LORNA RD STE 5
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5454
Practice Address - Country:US
Practice Address - Phone:205-823-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU37118Medicare UPIN