1952306953 NPI number — DR. RUSSELL WILLIAM BLOXTON D.C.

Table of content: DR. RUSSELL WILLIAM BLOXTON D.C. (NPI 1952306953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952306953 NPI number — DR. RUSSELL WILLIAM BLOXTON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOXTON
Provider First Name:
RUSSELL
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1952306953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 THUNDER DR
Provider Second Line Business Mailing Address:
STE 209
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92083-6052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-941-3132
Provider Business Mailing Address Fax Number:
760-687-7441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 THUNDER DR
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92083-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-941-3132
Provider Business Practice Location Address Fax Number:
760-687-7441
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  23747 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: DC23747 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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