Healthcare Provider Details

I. General information

NPI: 1033175740
Provider Name (Legal Business Name): JAMES RUSSELL ADAMS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N 5TH AVE
KANKAKEE IL
60901-2212
US

IV. Provider business mailing address

840 N 5TH AVE
KANKAKEE IL
60901-2212
US

V. Phone/Fax

Practice location:
  • Phone: 815-383-3866
  • Fax:
Mailing address:
  • Phone: 815-383-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-003809
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: