Organization Active NPI

Fleetwood Chiropractic PC

  • Chiropractor
  • Mount Vernon, NY
National Provider Identifier
1821282930
Registry record updated Aug 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X002707C-1 Issued in NY
Legal business name
FLEETWOOD CHIROPRACTIC PC
Practice address
25 E Broad St
Mount Vernon, NY 10552-2207
Phone
(914) 699-6770
Fax
(914) 664-0090
NPI assigned
Aug 31, 2007
Last updated
Aug 31, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2007

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

Authorized official

Name
Dr. Robert Alan Russell Jr., D.C.NPI 1104850684
Title
President
Phone
(914) 699-6770

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X002707C-1 NY Primary
Chiropractor 111N00000X X004166-1 NY

Addresses

Primary practice location

25 E Broad St
Mount Vernon, NY 10552-2207

Mailing address

25 E Broad St
Mount Vernon, NY 10552-2207
Phone (914) 699-6770

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188518400000",
    "number": "1821282930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 E BROAD ST",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105522207",
            "telephone_number": "914-699-6770",
            "fax_number": "914-664-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 E BROAD ST",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105522207",
            "telephone_number": "914-699-6770",
            "fax_number": "914-664-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLEETWOOD CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-31",
        "last_updated": "2007-08-31",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "914-699-6770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X002707C-1",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X004166-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.