Organization
RUSSELL CHIROPRACTIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A RUSSELL DC (OWNER)
(216) 221-1788
Entity
Organization
Contact information
Practice address
18624 DETROIT AVE, LAKEWOOD, OH 44107-3202
(216) 221-1788
(216) 221-2820
Mailing address
18624 DETROIT AVE, LAKEWOOD, OH 44107-3202
(216) 221-1788
(216) 221-2820
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3307
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2321553
—
OH
01
—
232365
ANTHEM
OH
01
—
299807273002
MEDICAL MUTUAL
OH
Enumeration date
03/05/2008
Last updated
03/06/2012
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