Individual
DR. CHANTAL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C., L.AC.
Contact information
Practice address
10793 TIERRASANTA BLVD STE A, SAN DIEGO, CA 92124-2629
(858) 573-1505
Mailing address
10793 TIERRASANTA BLVD STE A, SAN DIEGO, CA 92124-2629
(858) 573-1505
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC29891
CA
171100000X
Acupuncturist
AC11156
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC11156
LICENSED ACUPUNCTURIST
CA
01
—
DC29891
CHIROPRACTOR
CA
Enumeration date
02/22/2007
Last updated
02/05/2016
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