Provider Demographics
NPI:1174774533
Name:WEST, JARED RUSSELL (DIPL AC NCCAOM)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:RUSSELL
Last Name:WEST
Suffix:
Gender:M
Credentials:DIPL AC NCCAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 GLENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2428
Mailing Address - Country:US
Mailing Address - Phone:216-401-3318
Mailing Address - Fax:
Practice Address - Street 1:25901 EMERY RD
Practice Address - Street 2:SUITE 114
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5774
Practice Address - Country:US
Practice Address - Phone:216-401-3318
Practice Address - Fax:216-765-4471
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist