Provider Demographics
NPI:1720193279
Name:DR ANN MARIE RUSSELL, CHIROPRACTOR, SC
Entity Type:Organization
Organization Name:DR ANN MARIE RUSSELL, CHIROPRACTOR, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-759-4949
Mailing Address - Street 1:498 W BOUGHTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1893
Mailing Address - Country:US
Mailing Address - Phone:630-759-4949
Mailing Address - Fax:630-759-1049
Practice Address - Street 1:498 W BOUGHTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1893
Practice Address - Country:US
Practice Address - Phone:630-759-4949
Practice Address - Fax:630-759-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty