Provider Demographics
NPI:1013088533
Name:CARAM, RUSSELL DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DAVID
Last Name:CARAM
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 1:182 GRASSY PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2807
Mailing Address - Country:US
Mailing Address - Phone:203-748-2499
Mailing Address - Fax:203-748-1381
Practice Address - Street 1:182 GRASSY PLAIN ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2807
Practice Address - Country:US
Practice Address - Phone:203-748-2499
Practice Address - Fax:203-748-1381
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT906111N00000X
CA20541111N00000X
NYX06581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor