Provider Demographics
NPI:1982311957
Name:RUSSELL KIMBALL LLC
Entity type:Organization
Organization Name:RUSSELL KIMBALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:605-377-5930
Mailing Address - Street 1:701 N 4TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2727
Mailing Address - Country:US
Mailing Address - Phone:605-377-5930
Mailing Address - Fax:
Practice Address - Street 1:701 N 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2727
Practice Address - Country:US
Practice Address - Phone:605-377-5930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty