Kerry Bruce Russell in Traverse City - Sports Physician
Kerry Bruce Russell - NPI 1093714222
Kerry Bruce Russell is a Sports Physician in Traverse City, Michigan. Kerry Bruce Russell practices all healthcare services and medical treatments related to Sports Physician. The NPI Number for Kerry Bruce Russell is 1093714222. The last update date is 2011-09-09.
Kerry Bruce Russell's current location address is 692 Hannah Ave, Traverse City, Michigan. You can contact this provider via phone number 2319472228 and fax number 2319472616. The mailing address for Kerry Bruce Russell is 692 Hannah Ave, Traverse City, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kerry Bruce Russell |
|---|---|
| Address | 692 Hannah Ave, Traverse City, Michigan |
| Phone Number | 2319472228 |
| Fax Number | 2319472616 |
| Sole Proprietor | Y |
| Credentials | D.C., C.C. |
NPI Number Detail
| NPI Number | 1093714222 |
|---|---|
| Provider Enumeration Date | 2005-07-19 |
| Last Updated Date | 2011-09-09 |
Provider Mailing Address Detail
| Address | 692 Hannah Ave |
|---|---|
| City | Traverse City |
| State | Michigan (MI) |
| Post Code | 496863110 |
| Phone Number | 2319472228 |
| Fax Number | 2319472616 |
Provider's Primary Taxonomy Detail
| Speciality | Sports Physician |
|---|---|
| Taxonomy | 111Ns0005X |
| Licence No | KR007665 |
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Definition: A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities. Doctors of Chiropractic with the Diplomate American Chiropractic Board of Sports Physicians (DACBSP) |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 4417133 | MI | -- | |
| P99464 | MI | BLUE CARE NETWORK | |
| U72489 | MI | PRIORITY HEALTH | |
| 611406599 | MI | PPOM | |
| 15934 | MI | MCARE | |
| 950B850440 | MI | BCBSM PPO |
Post Comment/ Review Below
What is the unique 10-digit identifier code assigned to Kerry Bruce Russell by the Centers for Medicare & Medicaid Services?
The Kerry Bruce Russell has been issued the NPI (National Provider Identifier) 1093714222 by the CMS (Centers for Medicare & Medicaid Services), which serves as a unique identification number for healthcare providers.
Could you kindly provide the complete physical address where Kerry Bruce Russell's facilities are geographically located?
The facilities of Kerry Bruce Russell are physically situated at the following location: 692 Hannah Ave, Traverse City, MI, 496863110.
What is Kerry Bruce Russell's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Kerry Bruce Russell is Sports Physician, and the taxonomy code that categorizes this field of expertise is 111Ns0005X.
On what date did the Centers for Medicare & Medicaid Services assign the 1093714222 to Kerry Bruce Russell?
The Centers for Medicare & Medicaid Services assigned the 1093714222 to Kerry Bruce Russell on 2005-07-19.
When was the information related to Kerry Bruce Russell most recently updated or refreshed?
The details pertaining to the Kerry Bruce Russell, including its address, specialty, and other relevant information, were last updated or refreshed on 2011-09-09.
NPI Number: 1730182858
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