Organization
RUSSELL WELLNESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY OWEN RUSSELL DC (OWNER)
(918) 333-3363
Entity
Organization
Contact information
Practice address
2523 SE WASHINGTON BLVD., BARTLESVILLE, OK 74006-8336
(918) 333-3363
Mailing address
2523 SE WASHINGTON BLVD., BARTLESVILLE, OK 74006-8336
(918) 333-3363
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3166
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF3888
PALMETTO GROUP
OK
Enumeration date
08/29/2007
Last updated
08/10/2011
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