Provider Demographics
NPI:1831245919
Name:WARR, RUSSELL (DC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:WARR
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 1:7012 RESEDA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4275
Mailing Address - Country:US
Mailing Address - Phone:818-998-5273
Mailing Address - Fax:818-998-5337
Practice Address - Street 1:7012 RESEDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4275
Practice Address - Country:US
Practice Address - Phone:818-998-5273
Practice Address - Fax:818-998-5337
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor