Provider Demographics
NPI:1669653911
Name:JANSSEN, RUSSELL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:THOMAS
Last Name:JANSSEN
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 1:2519 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4159
Mailing Address - Country:US
Mailing Address - Phone:727-726-8822
Mailing Address - Fax:727-796-9139
Practice Address - Street 1:2519 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4173
Practice Address - Country:US
Practice Address - Phone:727-726-8822
Practice Address - Fax:727-796-9139
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350005997OtherRR MEDICARE
FL381371100Medicaid
FLT54967OtherUPIN
FL381371100Medicaid