Provider Demographics
NPI:1376577783
Name:JUSTUS, RUSSELL ARVILLE (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ARVILLE
Last Name:JUSTUS
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 1:2244 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-6154
Mailing Address - Country:US
Mailing Address - Phone:423-581-4959
Mailing Address - Fax:423-581-4954
Practice Address - Street 1:2244W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3206
Practice Address - Country:US
Practice Address - Phone:423-581-4959
Practice Address - Fax:423-581-4954
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725094Medicare ID - Type Unspecified
TNU85122Medicare UPIN
TN3971734Medicare ID - Type Unspecified