Individual
RUSSELL DAVID BROCCOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
635 HOPE STREET, PROVIDENCE, RI 02906
(401) 351-6390
(401) 331-0614
Mailing address
635 HOPE STREET, PROVIDENCE, RI 02906
(401) 351-6390
(401) 331-0614
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DCP00204
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204088
BLUE CHIP
RI
01
—
90476
BCBS
RI
Enumeration date
11/28/2006
Last updated
07/08/2007
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