Mauk, Russell Howard
Mauk, Russell Howard is an sole proprietor health care provider with primary practice located at 8820 Goodman Rd , Olive Branch MS 38654-2204. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Mauk, Russell Howard can be contacted via phone (662) 890-5454.Contact Information
Primary practice address
8820 Goodman Rd
Olive Branch MS 38654-2204
Phone: (662) 890-5454
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 1079 | Mississippi |
| Chiropractic Providers / Chiropractor | 111N00000X | 1999 | Tennessee |
Profile Details
| NPI number | 1770509929 |
|---|---|
| LBN Legal business name | Mauk, Russell Howard |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 14th, 2006 |
| Last updated | Oct 30th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770509929 | NPPES |
| Mississippi | Other | 1174676647 | GROUP NPI |
| Mississippi | MEDICAID | 02858341 | GROUP NPI |
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