| Health Source Of James Island | |
|
1175 Folly Rd, Suite E, Charleston, SC 29412-4130 | |
| (843) 225-1236 | |
| (843) 225-1237 |
| Full Name | Health Source Of James Island |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 1175 Folly Rd, Charleston, South Carolina |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871894816 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 3605 (South Carolina) | Primary |
| Provider Name | Lee D Russo |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1841407616 PECOS PAC ID: 6800872821 Enrollment ID: I20110215001206 |
| Mailing Address | Practice Location Address |
|---|---|
| Health Source Of James Island 1175 Folly Rd, Suite E, Charleston, SC 29412-4130 Ph: (843) 225-1236 | Health Source Of James Island 1175 Folly Rd, Suite E, Charleston, SC 29412-4130 Ph: (843) 225-1236 |
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