# MR. CARL JAMES RUSSO JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1952635328
- **Gender:** Man
- **Credential:** DC STUDENT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | X011856-1 | NY | Yes |

## Other

- **Enumeration date:** 10/01/2009
- **Last updated:** 07/22/2011