Jacquelyn Michele Russell, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4384-012 Issued in WI

Practice address

425 Bridge St
Cornell, WI 54732-8391

Phone

(715) 239-0909

Fax

(715) 239-0908

NPI assigned

Oct 10, 2006

Sex

Female

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

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - West Sunnyvale, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Russell Chiropractic LLC 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Russell Chiropractic LLC

  • Chiropractor
  • Cornell, WI
  • NPI 1548567662
  Medicare reassignment Care Compare group NPD Authorized official
• Cornell Chiropractic, LLC

  • Chiropractor
  • Cornell, WI
  • NPI 1386744019
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298592000000",
    "number": "1669560413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 BRIDGE ST",
            "city": "CORNELL",
            "state": "WI",
            "postal_code": "547328391",
            "telephone_number": "715-239-0909",
            "fax_number": "715-239-0908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 BRIDGE ST",
            "city": "CORNELL",
            "state": "WI",
            "postal_code": "547328391",
            "telephone_number": "715-239-0909",
            "fax_number": "715-239-0908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JACQUELYN",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2011-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4384-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38183500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NSH Cornell LLC
• Katie Oliver
• Kaejan T Pederson, MS CCC-SLP
• Eric Gerald Phelps
• Russell Chiropractic LLC
• RWG Co Inc
• Bradley Bovee Schauer, PA
• Jane Pearl Stoik, RPH
• Sunrise Transportation-SRT
• Nelda Joy Thomas, PT

• All providers in Cornell, WI
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.