Individual
DR. MICHAEL RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
400 W MAIN ST, BRANFORD, CT 06405-3416
(203) 483-7778
(203) 481-0234
Mailing address
400 WEST MAIN STRRET, BRANFORD, CT 06405-3416
(203) 483-7778
(203) 481-0234
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
000561
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000561
STATE LICENSE
CT
Enumeration date
03/08/2006
Last updated
01/19/2012
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