Provider Demographics
NPI:1710345392
Name:MYERS, RUSSEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:
Last Name:MYERS
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 1:22633 TOWN CRIER RD
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-5731
Mailing Address - Country:US
Mailing Address - Phone:818-631-5618
Mailing Address - Fax:
Practice Address - Street 1:16624 MARQUEZ AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3233
Practice Address - Country:US
Practice Address - Phone:310-230-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor