Provider Demographics
NPI:1871184846
Name:RUSSELL, JOHN TAYLOR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TAYLOR
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1580 MONTGOMERY HWY STE 14
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4585
Mailing Address - Country:US
Mailing Address - Phone:205-637-1363
Mailing Address - Fax:205-637-1391
Practice Address - Street 1:1580 MONTGOMERY HWY STE 14
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-4585
Practice Address - Country:US
Practice Address - Phone:205-637-1363
Practice Address - Fax:205-637-1391
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor