Healthcare Provider Details

I. General information

NPI: 1316951338
Provider Name (Legal Business Name): RUSSELL EARL MCDANIEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N RANGE LINE RD
JOPLIN MO
64801-9765
US

IV. Provider business mailing address

3301 N RANGE LINE RD
JOPLIN MO
64801-9765
US

V. Phone/Fax

Practice location:
  • Phone: 417-206-2225
  • Fax: 417-206-2227
Mailing address:
  • Phone: 417-206-2225
  • Fax: 417-206-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4863
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6433
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number6433
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6433
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number6433
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number6433
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: