Provider Demographics
NPI:1295915049
Name:KERSHEN, RUSSELL RONALD (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:RONALD
Last Name:KERSHEN
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 1:1701 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-3834
Mailing Address - Country:US
Mailing Address - Phone:806-655-8777
Mailing Address - Fax:806-655-8790
Practice Address - Street 1:1701 5TH AVE
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-3834
Practice Address - Country:US
Practice Address - Phone:806-655-8777
Practice Address - Fax:806-655-8790
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00059871OtherRAILROAD MEDICARE
TX8AJ757OtherBCBS
TX001855801Medicaid
TX001855801Medicaid