Provider Demographics
NPI:1821215468
Name:PRAUSE, RUSSELL WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:WAYNE
Last Name:PRAUSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-1862
Mailing Address - Country:US
Mailing Address - Phone:979-732-6326
Mailing Address - Fax:
Practice Address - Street 1:1216 WALNUT ST
Practice Address - Street 2:SUITE B.
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-2127
Practice Address - Country:US
Practice Address - Phone:979-732-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor