Individual
DR. MICHAEL A RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
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
01
—
000000232365
ANTHEM
OH
05
—
2321553
—
OH
Enumeration date
09/22/2006
Last updated
03/06/2012
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