Provider Demographics
NPI:1255725974
Name:DR. SARAH RUSS, DC, S.C.
Entity type:Organization
Organization Name:DR. SARAH RUSS, DC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-470-5737
Mailing Address - Street 1:1259 RICKERT DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8904
Mailing Address - Country:US
Mailing Address - Phone:630-470-5737
Mailing Address - Fax:630-357-7974
Practice Address - Street 1:1259 RICKERT DRIVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8904
Practice Address - Country:US
Practice Address - Phone:630-470-5737
Practice Address - Fax:630-357-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012764305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization