Bryan C Russell

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

BRYAN C RUSSELL

Doing business as

Elite Spine and Sport Center

Practice address

651 Route 73 N Ste 304
Marlton, NJ 08053-3446

Phone

(856) 983-4499

Fax

(856) 983-0435

NPI assigned

May 19, 2006

Last updated

Dec 28, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bryan C Russell, DCNPI 1558366781

Title

Owner

Phone

(856) 983-4499

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Elite Spine and Sport Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bryan C Russell, DC

  • Chiropractor
  • Marlton, NJ
  • NPI 1558366781
  Medicare reassignment NPD Authorized official
• Geoffrey Richard Berard, D.C

  • Chiropractor
  • Marlton, NJ
  • NPI 1104177278
  NPD (past)
• Theodora Christine Caraway, D.C.

  • Chiropractor
  • Sewell, NJ
  • NPI 1558366799
  NPD (past)
• Paul Joseph Merlino III, D.C.

  • Orthopedic Chiropractor
  • Marlton, NJ
  • NPI 1417055435
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1336193119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 ROUTE 73 N STE 304",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533446",
            "telephone_number": "856-983-4499",
            "fax_number": "856-983-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 ROUTE 73 N STE 304",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533446",
            "telephone_number": "856-983-4499",
            "fax_number": "856-983-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN C RUSSELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-983-4499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH/KEYSTONE",
            "identifier": "0519113000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1055389",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2035367",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTCARE",
            "identifier": "2153560",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Spine and Sport Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elite Spine and Sport Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Nellie Brown, DPT
• Lauren Brown, CMA
• Stacie Brown
• Taylor Brubaker
• Kim Lisa Brunnet, APRN
• Alicia Yvonne Bryant-Rodgers, CRNP
• BSH Health NJ, P.C.
• Stefani Buck-Bivens, MS, CCC-SLP
• Lidiya Bukenova
• Katie Bullock, CD, CBC

• Chiropractor in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.