MEDICARE: RUSSELL L JONES D.C.

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
1	111N00000X	Chiropractor	561	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023091238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL L JONES D.C.

Provider Business Mailing Address
First Line	:	100 WESTMORELAND OFFICE PARK
Second Line	:
City	:	DUNBAR
State	:	WV
Zip	:	25064-2725
Country	:	US
Telephone Number	:	304-768-5068
Fax Number	:	304-768-6251

Provider Business Practice Location Address
First Line	:	100 WESTMORELAND OFFICE CENTER
Second Line	:
City	:	DUNBAR
State	:	WV
Zip	:	25064-2725
Country	:	US
Telephone Number	:	304-768-5068
Fax Number	:	304-768-6251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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