Russell Jeriah Prentice, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3725 Issued in OK

Practice address

9428 S Elwood Ave
Suite 102
Jenks, OK 74037-2317

Phone

(918) 296-0525

Fax

(918) 296-0526

NPI assigned

Oct 10, 2005

Reactivated

Jan 4, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Active Body Chiropractic & Rehabilitation, PLLC

  • Chiropractor
  • Jenks, OK
  • NPI 1417188301
  NPD (past)
• Prentice Family Chiropractic PLLC

  • Chiropractor
  • Jenks, OK
  • NPI 1104991280
  NPD (past)
• Shearwood Chiropractic Clinic Inc

  • Chiropractor
  • Stigler, OK
  • NPI 1033105861
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518955947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9428 S ELWOOD AVE",
            "address_2": "SUITE 102",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372317",
            "telephone_number": "918-296-0525",
            "fax_number": "918-296-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9428 S ELWOOD AVE",
            "address_2": "SUITE 102",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372317",
            "telephone_number": "918-296-0525",
            "fax_number": "918-296-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENTICE",
        "first_name": "RUSSELL",
        "middle_name": "JERIAH",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2007-07-08",
        "deactivation_date": "2006-12-29",
        "reactivation_date": "2007-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI PRENTICE FAMILY",
            "identifier": "1104991280",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Pogany
• Kelsey Postoak, PA-C
• Brooke Anne Powell, PTA
• John Micah H Powers, DO
• Prentice Family Chiropractic PLLC
• Elizabeth Leann Presley
• Kaylee Jane Primeaux, PROVIDER
• Progressive Healing Therapeutic Practice, LLC
• Tremayne Prudhomme, PT
• Rachael Johnson LLC

• Chiropractor in Jenks, OK
• Providers in Jenks, OK by specialty
• Chiropractor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.