Individual
RUSSELL JERIAH PRENTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
9428 S ELWOOD AVE, SUITE 102, JENKS, OK 74037-2317
(918) 296-0525
(918) 296-0526
Mailing address
9428 S ELWOOD AVE, SUITE 102, JENKS, OK 74037-2317
(918) 296-0525
(918) 296-0526
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3725
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104991280
GROUP NPI PRENTICE FAMILY
—
Enumeration date
10/10/2005
Last updated
07/08/2007
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