Provider Demographics
NPI:1700965951
Name:FRISILLO, RUSSELL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JAMES
Last Name:FRISILLO
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 1:710 N ELM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2574
Mailing Address - Country:US
Mailing Address - Phone:918-251-9975
Mailing Address - Fax:918-251-9259
Practice Address - Street 1:710 N ELM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2574
Practice Address - Country:US
Practice Address - Phone:918-251-9975
Practice Address - Fax:918-251-9259
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK3296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor