Ty D Russell, D.C. Valid NPI

Individual provider · Chiropractor · Gravette, AR

NPI

1487961322

Type

Individual (Type 1)

Primary specialty

Chiropractor

Specialty group

Chiropractic Providers

Taxonomy code

111N00000X

License number

15,726 (AR)

Sex

Male

Sole proprietor

No

Enumerated

2010-09-13

Last updated

2014-09-17