| Dr Larry J Russell Inc | |
|
406 E South Blvd Crawfordsville IN 47933-3762 | |
| (765) 362-1111 | |
| (765) 362-2609 |
| Full Name | Dr Larry J Russell Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 406 E South Blvd, Crawfordsville, Indiana |
| Authorized Official Name and Position | Larry J Russell (PRESIDENT) |
| Authorized Official Contact | 7653621111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Larry J Russell Inc 406 E South Blvd Crawfordsville IN 47933-3762 Ph: (765) 362-1111 | Dr Larry J Russell Inc 406 E South Blvd Crawfordsville IN 47933-3762 Ph: (765) 362-1111 |
| NPI Number | 1225388044 |
|---|---|
| Provider Enumeration Date | 09/19/2012 |
| Last Update Date | 09/19/2012 |
| Medicare PECOS PAC ID | 8820237845 |
|---|---|
| Medicare Enrollment ID | O20130622000041 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225388044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 08000620A (Indiana) | Primary |
| Provider Name | Larry J Russell |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1841228731 PECOS PAC ID: 0244335743 Enrollment ID: I20070411000359 |
| Provider Name | Ryan Russell |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1265890669 PECOS PAC ID: 9830498013 Enrollment ID: I20160422001653 |
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