Russell Kelso Davis, D.C.
Individual provider Active NPI Sports Physician Chiropractor · Havelock, NC
NPI 1982607966 · NPPES record last updated May 17, 2016
Key facts
- NPI
- 1982607966
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Physician Chiropractor 111NS0005X
- License
- 2801 (NC)
- Practice address
- 318 E. Main St.
Havelock, NC 28532-2214 - Phone
- (252) 444-3377
- Fax
- (252) 444-3529
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
318 E Main St
Havelock, NC 28532-2214
Phone (252) 444-3377
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100209000397 | NC | Practitioner - Chiropractic | 5890838171 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2801 | NC | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sprague, PLLC | Past | Accepting new patients | |
| Schilsky Chiropractic Center PA | Sports Physician | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 2801 | NC | Yes |
Addresses
Primary practice location
318 E. Main St.
Havelock, NC 28532-2214
Mailing address
318 E. Main St.
Naval Hospital
Havelock, NC 28532-2214
Phone (252) 444-3377
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 616120 | Other | NC | ACN IDENTIFICATION # |
| 7167352 | Other | NC | AETNA PROVIDER # |
| 0844V | Other | NC | BCBS PROVIDER # |
| 890844V | Medicaid | NC |
Other providers in Havelock, NC
- Jillian Daigneault
- Natasia Sara Daloisio
- Samantha D Davidson
- Adam Toliver Davis
- Matthew John Davis
- William Dees
- Alivia Delisle-Isfeld
- John Eric Demoret
- Douglas Harold Desantis
- Joseph Conrad Deschuytner
All providers in Havelock, NC · Sports Physician Chiropractor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2016. 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.