Provider Demographics
NPI:1801040241
Name:TRUSSELL, JULIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:TRUSSELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ROBOTHAM TRUSSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1325 E THOUSAND OAKS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6258
Mailing Address - Country:US
Mailing Address - Phone:805-901-1184
Mailing Address - Fax:
Practice Address - Street 1:1325 E THOUSAND OAKS BOULEVARD SUITE 104
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2822
Practice Address - Country:US
Practice Address - Phone:805-371-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CZ200Medicare PIN
54440Medicare UPIN