Kerry Bruce Russell, D.C., C.C.S.P.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

KR007665 Issued in MI

Practice address

692 Hannah Ave
Suite a
Traverse City, MI 49686-3110

Phone

(231) 947-2228

Fax

(231) 947-2616

NPI assigned

Jul 19, 2005

Reactivated

Mar 24, 2006

Last updated

Sep 9, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Chiropractic

Education

National College of Chiropractic, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Russell Chiropractic, PLCGroup PAC ID 1759451362, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: krussell@rctc0001.direct.chirotouch.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Russell Chiropractic, PLC

  • Chiropractor
  • Traverse City, MI
  • NPI 1700044104
  Medicare reassignment Care Compare group NPD Authorized official
• Natural Advantage Chiropractic, PLLC

  • Chiropractor
  • Traverse City, MI
  • NPI 1619394533
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315526400000",
    "number": "1093714222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "692 HANNAH AVE",
            "address_2": "SUITE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863110",
            "telephone_number": "231-947-2228",
            "fax_number": "231-947-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "692 HANNAH AVE",
            "address_2": "SUITE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863110",
            "telephone_number": "231-947-2228",
            "fax_number": "231-947-2616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KERRY",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "D.C., C.C.S.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2011-09-09",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "MI",
            "license": "KR007665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PPO",
            "identifier": "950B850440",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "U72489",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4417133",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "P99464",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "15934",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPOM",
            "identifier": "611406599",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Russell Van Houzen, MD, PLC
• Andrea Synnestvedt Russell, LMSW
• Christine A Russell, MSRD
• Erynne Louise Russell
• Jodi K Russell
• Krsity Marie Russell
• Mariah Lynn Russell
• Naila Christine Russell, DNP, FNP-BC
• Samantha M Ruth, MA LLP
• Ryan a Paulson DDS PC

• Sports Physician Chiropractor in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Sports Physician Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.