Provider Demographics
NPI:1356602031
Name:RUSSELL ELBA D.C.P.A
Entity type:Organization
Organization Name:RUSSELL ELBA D.C.P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:ELBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-961-2245
Mailing Address - Street 1:5810 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1527
Mailing Address - Country:US
Mailing Address - Phone:954-961-2245
Mailing Address - Fax:954-961-3344
Practice Address - Street 1:5810 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1527
Practice Address - Country:US
Practice Address - Phone:954-961-2245
Practice Address - Fax:954-961-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU12717Medicare UPIN