Provider Demographics
NPI:1760093223
Name:RUSSELL, AUDREY A (DC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:A
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5614 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3434
Mailing Address - Country:US
Mailing Address - Phone:314-502-9089
Mailing Address - Fax:314-370-2926
Practice Address - Street 1:5614 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3434
Practice Address - Country:US
Practice Address - Phone:314-502-9089
Practice Address - Fax:314-370-2926
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO08003158A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor