Provider Demographics
NPI:1598866857
Name:RUSSELL L JONES D C CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:RUSSELL L JONES D C CHIROPRACTIC CORPORATION
Other - Org Name:SMITH & JONES CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-768-5068
Mailing Address - Street 1:100 WESTMORELAND OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-2725
Mailing Address - Country:US
Mailing Address - Phone:304-768-5068
Mailing Address - Fax:304-768-6251
Practice Address - Street 1:100 WESTMORELAND OFFICE PARK
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2725
Practice Address - Country:US
Practice Address - Phone:304-768-5068
Practice Address - Fax:304-768-6251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1023091238OtherR L JONES NPI
WV3810017569Medicaid
WV1073797379OtherNPI
WV2203045000Medicaid
WV0131699000Medicaid
WV1073596284OtherJ S MORRIS NPI
WVU88191Medicare UPIN
WV2203045000Medicaid
WV0131699000Medicaid
WV3810017569Medicaid
WVMC4287091Medicare PIN