Timothy Wade Russell, D.C.
Individual provider Active NPI Chiropractor · Remsen, IA
NPI 1306048491 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1306048491
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- A0 5501 (IA)
- Practice address
- 325 E. Hawkeye Ave.
Remsen, IA 51050-0086 - Phone
- (712) 786-2989
- Fax
- (712) 786-2220
- NPI assigned
- Jun 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
325 E Hawkeye Dr
Remsen, IA 51050-1040
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050421001517 | IA | Practitioner - Chiropractic | 1153369897 | Practice locations: Remsen, IA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A0 5501 | IA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | A0 5501 | IA | Yes |
Addresses
Primary practice location
325 E. Hawkeye Ave.
Remsen, IA 51050-0086
Mailing address
325 E. Hawkeye Ave.
P.O. Box 86
Remsen, IA 51050-0086
Phone (712) 786-2989
Other providers in Remsen, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.