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Organization
BRYAN C RUSSELL
Active
Organization
BRYAN C RUSSELL
Active
Other names
Elite Spine and Sport Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN C RUSSELL DC (OWNER)
(856) 983-4499
Entity
Organization
Contact information
Practice address
651 ROUTE 73 N STE 304, MARLTON, NJ 08053-3446
(856) 983-4499
(856) 983-0435
Mailing address
651 ROUTE 73 N STE 304, MARLTON, NJ 08053-3446
(856) 983-4499
(856) 983-0435
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0519113000
AMERIHEALTH/KEYSTONE
NJ
01
—
1055389
CIGNA
NJ
01
—
2035367
AETNA
NJ
01
—
2153560
UNITED HEALTCARE
NJ
Enumeration date
05/19/2006
Last updated
12/28/2023
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