Provider Demographics
NPI:1780157248
Name:MORTER, RUSSELL THOMAS (DC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:THOMAS
Last Name:MORTER
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 1:522 N CURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-3817
Mailing Address - Country:US
Mailing Address - Phone:479-451-9200
Mailing Address - Fax:
Practice Address - Street 1:522 N CURTIS AVE
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-3817
Practice Address - Country:US
Practice Address - Phone:479-451-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor