NPIMap

Organization Active NPI

Derek D. Russell, D.C., Inc.

  • Chiropractor
  • Virginia Beach, VA
National Provider Identifier
1639369291
Registry record updated Jul 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104555920 Issued in VA
Legal business name
DEREK D. RUSSELL, D.C., INC.
Practice address
2125 McComas Way
Suite 101
Virginia Beach, VA 23456-3986
Phone
(757) 427-7690
Fax
(757) 427-7692
NPI assigned
Jul 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2007

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

Authorized official

Name
Dr. Derek Duncan Russell, D.C.NPI 1922173822
Title
Chiropractor/Director
Phone
(757) 427-7690

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 0104555920 VA Primary

Addresses

Primary practice location

2125 McComas Way
Suite 101
Virginia Beach, VA 23456-3986

Mailing address

2125 McComas Way
Suite 101
Virginia Beach, VA 23456-3986
Phone (757) 427-7690

Other names 1

  • Nimmo Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081105000846 VA Part B Supplier - Clinic/Group Practice 4880753896 Receives reassigned benefits from 1 practitioner
Practice locations: Virginia Beach, VA

National Provider Directory

National Provider Directory

Locations

2125 McComas Way
Ste 101
Virginia Beach, VA 23456
Phone (757) 427-7690

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1639369291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 MCCOMAS WAY",
            "address_2": "SUITE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234563986",
            "telephone_number": "757-427-7690",
            "fax_number": "757-427-7692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 MCCOMAS WAY",
            "address_2": "SUITE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234563986",
            "telephone_number": "757-427-7690",
            "fax_number": "757-427-7692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK D. RUSSELL, D.C., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "DUNCAN",
        "authorized_official_title_or_position": "CHIROPRACTOR/DIRECTOR",
        "authorized_official_telephone_number": "757-427-7690",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104555920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nimmo Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; 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.