1558458026 NPI number — RUSSELL R HAUSER DC LLC

Table of content: (NPI 1558458026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558458026 NPI number — RUSSELL R HAUSER DC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSSELL R HAUSER DC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558458026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N72 W28550 SUSSEX ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTLAND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-538-1628
Provider Business Mailing Address Fax Number:
262-538-1630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N72 W28550 SUSSEX ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-538-1628
Provider Business Practice Location Address Fax Number:
262-538-1630
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAUSER
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
262-538-1628

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2171 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1891809422 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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