Provider Demographics
NPI:1295717072
Name:LEWANDOWSKI, RUSSELL JACK (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JACK
Last Name:LEWANDOWSKI
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 1:741 N. COUNTRY CLUB DR.
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-5405
Mailing Address - Country:US
Mailing Address - Phone:352-726-0888
Mailing Address - Fax:352-795-8911
Practice Address - Street 1:2800 W. GULF TO LAKE HWY.
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9205
Practice Address - Country:US
Practice Address - Phone:352-726-0888
Practice Address - Fax:352-795-8911
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55273Medicare ID - Type UnspecifiedBLUE CROSS BLUE SHEILD