Individual
RUSS C. REDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1269 S MAIN ST, WAKE FOREST, NC 27587-9282
(919) 556-2014
(919) 556-0996
Mailing address
1269 S MAIN ST, WAKE FOREST, NC 27587-9282
(919) 556-2014
(919) 556-0996
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3405
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085WC
BLUE CROSS BLUE SHIELD/NC
NC
01
—
561294023
TAX ID#
NC
01
—
681277
ACN
NC
01
—
PHCS
9400767
NC
Enumeration date
07/07/2006
Last updated
01/16/2020
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