Individual
DR. TY D RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
207 ATLANTA STREET S.E., GRAVETTE, AR 72736
(479) 787-7555
(479) 787-7444
Mailing address
207 ATLANTA STREET S.E., GRAVETTE, AR 72736
(479) 787-7555
(479) 787-7444
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
15,726
AR
Other
Enumeration date
09/13/2010
Last updated
09/17/2014
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