Provider Demographics
NPI:1801947585
Name:RUSSELL, LEROY CURTIS (DC)
Entity type:Individual
Prefix:DR
First Name:LEROY
Middle Name:CURTIS
Last Name:RUSSELL
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 1:1714 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1506
Mailing Address - Country:US
Mailing Address - Phone:334-834-6282
Mailing Address - Fax:334-834-6418
Practice Address - Street 1:1714 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1506
Practice Address - Country:US
Practice Address - Phone:334-834-6282
Practice Address - Fax:334-834-6418
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51035505OtherBCBS OF ALABAMA
ALU67337OtherVIVA HEALTH
AL4410370OtherUNITED HEALTHCARE
AL51097398OtherBCBS OF ALABAMA
ALA9494OtherHEALTHSPRING OF ALABAMA
ALU67337OtherVIVA HEALTH
ALU67337Medicare UPIN