Provider Demographics
NPI:1740484443
Name:RUSSELL AND ROSS CHIROPRACTIC CENTRE
Entity type:Organization
Organization Name:RUSSELL AND ROSS CHIROPRACTIC CENTRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-786-6055
Mailing Address - Street 1:755 SUNRISE AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4500
Mailing Address - Country:US
Mailing Address - Phone:916-786-6055
Mailing Address - Fax:916-786-6452
Practice Address - Street 1:755 SUNRISE AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4500
Practice Address - Country:US
Practice Address - Phone:916-786-6055
Practice Address - Fax:916-786-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP-00059778OtherRAILROAD MEDICARE
CAP-00059778OtherRAILROAD MEDICARE