Provider Demographics
NPI:1942344221
Name:RUSS, DAVID B (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:RUSS
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 1:7928 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3021
Mailing Address - Country:US
Mailing Address - Phone:503-754-6136
Mailing Address - Fax:503-221-5454
Practice Address - Street 1:1020 SW TAYLOR ST
Practice Address - Street 2:#330
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2543
Practice Address - Country:US
Practice Address - Phone:503-287-4970
Practice Address - Fax:503-221-5454
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor