Provider Demographics
NPI:1831429745
Name:RUSSEAU, RONALD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOSEPH
Last Name:RUSSEAU
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 1:105 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1951
Mailing Address - Country:US
Mailing Address - Phone:517-423-3600
Mailing Address - Fax:517-423-1452
Practice Address - Street 1:105 S PEARL ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1951
Practice Address - Country:US
Practice Address - Phone:517-423-3600
Practice Address - Fax:517-423-1452
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8089111N00000X
MI2301010320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor