Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | DC1171 | TN |
N | 111NX0100X | Occupational Health | DC1171 | TN |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC1171 | TN |
NPI | 1528172368 |
---|---|
Provider Name | Dr. Russell D. Radican |
First Address | Memphis, TN 38119-0705 |
Second Address | Memphis, TN 38119-0705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3009201 | BLUECROSSBLUESHIELD (01) | TN |
5829049 | AETNA HMO (01) | TN |
61387800-03 | CIGNA (01) | TN |
61387800-04 | CIGNA HMO (01) | TN |
U54784 | (02) | TN |