Provider Demographics
NPI:1790739324
Name:HARWARD, RUSSELL VAL SR (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:VAL
Last Name:HARWARD
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11616 S STATE ST
Mailing Address - Street 2:SUITE 1502
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7125
Mailing Address - Country:US
Mailing Address - Phone:801-571-2200
Mailing Address - Fax:801-816-1048
Practice Address - Street 1:11616 S STATE ST
Practice Address - Street 2:SUITE 1502
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7125
Practice Address - Country:US
Practice Address - Phone:801-571-2200
Practice Address - Fax:801-816-1048
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT172703-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870560087OtherSELECTHEALTH
UTDE0098OtherPALMETTO GBA - RAILROAD
UT0004464362OtherAETNA
UT870560087OtherUNITED HEALTH CARE
UT870560087OtherMAIL HANDLERS
UT870560087-001OtherMBA
UT870560087OtherSELECTHEALTH