Provider Demographics
NPI:1245226653
Name:MAAS, RUSSELL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JOHN
Last Name:MAAS
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 1:117 B EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEYWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:61745
Mailing Address - Country:US
Mailing Address - Phone:309-473-3798
Mailing Address - Fax:309-473-3830
Practice Address - Street 1:117 B EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:HEYWORTH
Practice Address - State:IL
Practice Address - Zip Code:61745
Practice Address - Country:US
Practice Address - Phone:309-473-3798
Practice Address - Fax:309-473-3830
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU73757Medicare UPIN
IL200659Medicare ID - Type Unspecified