Provider Demographics
NPI:1487759528
Name:MCARTHUR, RUSSEL EARL (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:EARL
Last Name:MCARTHUR
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 1:4808 GREAT RIVER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-2664
Mailing Address - Country:US
Mailing Address - Phone:601-693-1100
Mailing Address - Fax:601-483-7435
Practice Address - Street 1:4808 GREAT RIVER DR
Practice Address - Street 2:SUITE E
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2664
Practice Address - Country:US
Practice Address - Phone:601-693-1100
Practice Address - Fax:601-483-7435
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115180Medicaid
MST20819Medicare UPIN
MS00115180Medicaid