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Individual

JASON D RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
1114 W COOK RD, FORT WAYNE, IN 46825-3214
(260) 483-5588
(260) 489-1819
Mailing address
2520 LINCROFT DR, FORT WAYNE, IN 46845-1916

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002372A
IN

Other

Enumeration date
01/11/2008
Last updated
01/11/2008
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