Provider Demographics
NPI:1952473530
Name:RUSSELL, SHERYL L (DC)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-2607
Mailing Address - Fax:978-927-2463
Practice Address - Street 1:319 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-2607
Practice Address - Fax:978-927-2463
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
351127OtherHPHC
Y36462OtherBCBS
MA1613006Medicaid
351127OtherHPHC
Y45101Medicare ID - Type Unspecified