Provider Demographics
NPI:1952382145
Name:RTJ DC INC
Entity Type:Organization
Organization Name:RTJ DC INC
Other - Org Name:DR. RUSSELL JANSSEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-726-8822
Mailing Address - Street 1:2519 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 MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4159
Practice Address - Country:US
Practice Address - Phone:727-726-8822
Practice Address - Fax:727-796-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350005997OtherRR MEDICARE
FL381371100Medicaid
FLAH566Medicare PIN
T54967Medicare UPIN