Healthcare Provider Details

I. General information

NPI: 1598866857
Provider Name (Legal Business Name): RUSSELL L JONES D C CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTMORELAND OFFICE PARK
DUNBAR WV
25064-2725
US

IV. Provider business mailing address

100 WESTMORELAND OFFICE PARK
DUNBAR WV
25064-2725
US

V. Phone/Fax

Practice location:
  • Phone: 304-768-5068
  • Fax: 304-768-6251
Mailing address:
  • Phone: 304-768-5068
  • Fax: 304-768-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number561
License Number StateWV

VIII. Authorized Official

Name: TERESA WITHROW
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-768-5068