Active NPI
Tyler J Russo, DC
- Chiropractor
- Freehold, NJ
National Provider Identifier
1770052391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 38MC00756900
- Practice address
- 222 South St
Freehold, NJ 07728-2619 - Phone
- (732) 409-6777
- NPI assigned
- Nov 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 38MC00756900 | NJ | Primary |
Addresses
Primary practice location
222 South St
Freehold, NJ 07728-2619
Mailing address
222 South St
Freehold, NJ 07728-2619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191127000033 | NJ | Practitioner - Chiropractic | 0042643348 | Practice locations: Freehold, NJ |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Life Chiropractic College, 2018
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
222 S St
Freehold, NJ 07728-2619
Phone (732) 409-6777
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38MC00756900 | NJ | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752624000000",
"number": "1770052391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 SOUTH ST",
"city": "FREEHOLD",
"state": "NJ",
"postal_code": "077282619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 SOUTH ST",
"city": "FREEHOLD",
"state": "NJ",
"postal_code": "077282619",
"telephone_number": "732-409-6777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "TYLER",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-14",
"last_updated": "2025-07-16",
"certification_date": "2025-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NJ",
"license": "38MC00756900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freehold, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; 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.