Provider Demographics
NPI:1730471061
Name:RUSSO, ELENA (DC)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SW 72ND ST
Mailing Address - Street 2:SUITE 333
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3012
Mailing Address - Country:US
Mailing Address - Phone:305-279-9255
Mailing Address - Fax:305-279-9258
Practice Address - Street 1:10300 SW 72ND ST
Practice Address - Street 2:SUITE 333
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:305-279-9255
Practice Address - Fax:305-279-9258
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH07007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor