Provider Demographics
NPI:1174525687
Name:RUSSELL, DAVID A (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4916
Mailing Address - Country:US
Mailing Address - Phone:972-567-6121
Mailing Address - Fax:972-562-4433
Practice Address - Street 1:2740 VIRGINIA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4916
Practice Address - Country:US
Practice Address - Phone:972-567-6121
Practice Address - Fax:972-562-4433
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6761111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605332Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
TXU59589Medicare UPIN