Provider Demographics
NPI:1033175740
Name:ADAMS, JAMES RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2212
Mailing Address - Country:US
Mailing Address - Phone:815-383-3866
Mailing Address - Fax:
Practice Address - Street 1:840 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2212
Practice Address - Country:US
Practice Address - Phone:815-383-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046 82101OtherBLUE CROSS BLUE SHIELD
IL350029131OtherRAILROAD MEDICARE
IL350029131OtherRAILROAD MEDICARE
IL216690Medicare ID - Type Unspecified