Provider Demographics
NPI:1972755494
Name:RUSSELL FOWLER LLC
Entity Type:Organization
Organization Name:RUSSELL FOWLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-652-9175
Mailing Address - Street 1:5213 E FELLARS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1138
Mailing Address - Country:US
Mailing Address - Phone:602-652-9175
Mailing Address - Fax:480-419-0424
Practice Address - Street 1:8700 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE 226
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3540
Practice Address - Country:US
Practice Address - Phone:480-502-9333
Practice Address - Fax:480-419-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty