Provider Demographics
NPI:1780844373
Name:RUSS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:RUSS FAMILY CHIROPRACTIC
Other - Org Name:RUSS CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-395-5066
Mailing Address - Street 1:5710 OLEANDER DR
Mailing Address - Street 2:STE 207
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4766
Mailing Address - Country:US
Mailing Address - Phone:910-395-5066
Mailing Address - Fax:910-777-2593
Practice Address - Street 1:5710 OLEANDER DR
Practice Address - Street 2:STE 207
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4766
Practice Address - Country:US
Practice Address - Phone:910-395-5066
Practice Address - Fax:910-777-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty