Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC20377 | CA |
NPI | 1598945305 |
---|---|
Provider Name | Dr. Todd David Russell |
First Address | Anaheim, CA 92801-5227 |
Second Address | Anaheim, CA 92801-5227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2007 |
Last Update Date | 08/11/2007 |