Provider Demographics
NPI:1932238078
Name:RUSSELL, FRANK MATTHEW (DC)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:MATTHEW
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 1:3948B CLEVELAND AVE SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4023
Mailing Address - Country:US
Mailing Address - Phone:360-754-7500
Mailing Address - Fax:360-754-7584
Practice Address - Street 1:3948B CLEVELAND AVE SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4023
Practice Address - Country:US
Practice Address - Phone:360-754-7500
Practice Address - Fax:360-754-7584
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB25350Medicare ID - Type Unspecified
WA912108094Medicare UPIN