Provider Demographics
NPI:1023091238
Name:JONES, RUSSELL L (DC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:L
Last Name:JONES
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 1:100 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 CENTER
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
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131699000Medicaid
WVJ00709922Medicare ID - Type Unspecified
WVU28307Medicare UPIN