Provider Demographics
NPI:1669728309
Name:DESMARAIS, RUSSELL C (DC, DABCI)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:C
Last Name:DESMARAIS
Suffix:
Gender:M
Credentials:DC, DABCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1826
Mailing Address - Country:US
Mailing Address - Phone:651-330-9456
Mailing Address - Fax:651-330-9843
Practice Address - Street 1:1036 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1826
Practice Address - Country:US
Practice Address - Phone:651-330-9456
Practice Address - Fax:651-330-9843
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1397111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist