Broccoli, Russell David

Broccoli, Russell David is an individual health care provider with primary practice located at 635 Hope Street , Providence RI 02906. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Broccoli, Russell David can be contacted via phone (401) 351-6390.

Contact Information

Primary practice address
635 Hope Street Providence RI 02906
Fax: (401) 331-0614
Website:

Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X DCP00204 Rhode Island

Profile Details

NPI number 1689740607
LBN Legal business name Broccoli, Russell David
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 28th, 2006
Last updated Jul 8th, 2007 - about 19 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 1689740607 NPPES
Rhode Island Other 90476 BCBS
Rhode Island Other 204088 BCBS

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