Provider Demographics
NPI:1316951338
Name:MCDANIEL, RUSSELL EARL (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:EARL
Last Name:MCDANIEL
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 1:3301 N RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-9765
Mailing Address - Country:US
Mailing Address - Phone:417-206-2225
Mailing Address - Fax:417-206-2227
Practice Address - Street 1:3301 N RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-9765
Practice Address - Country:US
Practice Address - Phone:417-206-2225
Practice Address - Fax:417-206-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6433111NP0017X, 111NS0005X, 171100000X, 111NN1001X, 111N00000X
KS4863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062121Medicare ID - Type Unspecified
KS062121Medicare UPIN
MO0000412251Medicare UPIN