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NPI Code Detail

MEDICARE: JASON D RUSSELL DC

MEDICARE: JASON D RUSSELL DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor08002372AIN

General Provider Information

NPI Number : 1215113089
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON D RUSSELL DC
Provider Business Mailing Address
First Line : 2520 LINCROFT DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1916
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1114 W COOK RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-3214
Country : US
Telephone Number : 260-483-5588
Fax Number : 260-489-1819
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2008
Last Update Date : 01/11/2008

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Directions to “ JASON D RUSSELL DC” Practice Location

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