Provider Demographics
NPI:1265438840
Name:FICARA, RUSSELL ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ANDREW
Last Name:FICARA
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:PO BOX 814385
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33081-4385
Mailing Address - Country:US
Mailing Address - Phone:954-920-5020
Mailing Address - Fax:954-966-6765
Practice Address - Street 1:2500 HOLLYWOOD BLVD
Practice Address - Street 2:SUIRE 409
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6615
Practice Address - Country:US
Practice Address - Phone:954-920-5020
Practice Address - Fax:954-966-6765
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380-296-500Medicaid
FL22577Medicare ID - Type Unspecified
U09422Medicare UPIN