Provider Demographics
NPI:1952306953
Name:BLOXTON, RUSSELL WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:WILLIAM
Last Name:BLOXTON
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 1:161 THUNDER DR
Mailing Address - Street 2:STE 209
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6052
Mailing Address - Country:US
Mailing Address - Phone:760-941-3132
Mailing Address - Fax:760-687-7441
Practice Address - Street 1:161 THUNDER DR
Practice Address - Street 2:STE 209
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6052
Practice Address - Country:US
Practice Address - Phone:760-941-3132
Practice Address - Fax:760-687-7441
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23747111N00000X
CADC23747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor