Individual
DR. KERRY BRUCE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., C.C.S.P.
Contact information
Practice address
692 HANNAH AVE, SUITE A, TRAVERSE CITY, MI 49686-3110
(231) 947-2228
(231) 947-2616
Mailing address
692 HANNAH AVE, SUITE A, TRAVERSE CITY, MI 49686-3110
(231) 947-2228
(231) 947-2616
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
KR007665
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15934
MCARE
MI
05
—
4417133
—
MI
01
—
611406599
PPOM
MI
01
—
950B850440
BCBSM PPO
MI
01
—
P99464
BLUE CARE NETWORK
MI
01
—
U72489
PRIORITY HEALTH
MI
Enumeration date
07/19/2005
Last updated
09/09/2011
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