MEDICARE: JOHN RUSSELL OWINGS 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	2301007550	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0D15130	OTHER	MI	BCBS
2	120443	OTHER	MI	PERFERRED CHOICES PPO
3	1034022	OTHER	MI	ASH
4	5489608	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1710958525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RUSSELL OWINGS D.C.

Provider Business Mailing Address
First Line	:	4310 LEONARD ST NW
Second Line	:	SUITE 103
City	:	WALKER
State	:	MI
Zip	:	49534-8447
Country	:	US
Telephone Number	:	616-453-0600
Fax Number	:	616-453-4268

Provider Business Practice Location Address
First Line	:	4310 LEONARD ST NW
Second Line	:	SUITE 103
City	:	WALKER
State	:	MI
Zip	:	49534-8447
Country	:	US
Telephone Number	:	616-453-0600
Fax Number	:	616-453-4268

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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