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
Phone: (401) 351-6390
Fax: (401) 331-0614
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1689740607 | NPPES |
| Rhode Island | Other | 90476 | BCBS |
| Rhode Island | Other | 204088 | BCBS |
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