| |
6624 Royal St, Pleasant Valley, MO 64068-8711 | |
(816) 824-9690 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Chiropractor |
Location | 6624 Royal St, Pleasant Valley, Missouri |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1609019587 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 2008015663 (Missouri) | Primary |
Provider Name | Renny B Russell |
---|---|
Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1003905456 PECOS PAC ID: 1456409085 Enrollment ID: I20090508000028 |
Mailing Address | Practice Location Address |
---|---|
6624 Royal St, Pleasant Valley, MO 64068-8711 Ph: (816) 824-9690 | 6624 Royal St, Pleasant Valley, MO 64068-8711 Ph: (816) 824-9690 |
Renny Beau Russell, DC Chiropractor Medicare: Medicare Enrolled Practice Location: 6624 Royal St, Pleasant Valley, MO 64068 Phone: 816-824-9690 |