Russell, Kerry Bruce

Russell, Kerry Bruce is an sole proprietor health care provider with primary practice located at 692 Hannah Ave Suite A, Traverse City MI 49686-3110. He recently has only one registered license in Chiropractic Providers / Sports Physician, which is considered as his primary health care specialty. Russell, Kerry Bruce can be contacted via phone (231) 947-2228.

Contact Information

Primary practice address
692 Hannah Ave Suite A Traverse City MI 49686-3110
Phone: (231) 947-2228
Fax: (231) 947-2616
Website:
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Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Sports Physician 111NS0005X KR007665 Michigan

Profile Details

NPI number 1093714222
LBN Legal business name Russell, Kerry Bruce
Credentials D.C., C.C.S.P.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 19th, 2005
Last updated Sep 9th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093714222 NPPES
Michigan MEDICAID 4417133
Michigan Other P99464
Michigan Other U72489
Michigan Other 611406599
Michigan Other 15934
Michigan Other 950B850440

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