Provider Demographics
NPI:1336213685
Name:LOGES, RUSSELL WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:WILLIAM
Last Name:LOGES
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 1:401 JOHNSON LN STE 101
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-6280
Mailing Address - Country:US
Mailing Address - Phone:941-484-5333
Mailing Address - Fax:
Practice Address - Street 1:401 JOHNSON LN STE 101
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6280
Practice Address - Country:US
Practice Address - Phone:941-484-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor