Provider Demographics
NPI:1972049195
Name:JAMES I TRUSSELL III
Entity type:Organization
Organization Name:JAMES I TRUSSELL III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:TRUSSELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:713-944-7761
Mailing Address - Street 1:4117 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2181
Mailing Address - Country:US
Mailing Address - Phone:713-944-7761
Mailing Address - Fax:713-944-0179
Practice Address - Street 1:4117 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2181
Practice Address - Country:US
Practice Address - Phone:713-944-7761
Practice Address - Fax:713-944-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty