MEDICARE: RICHARD JOSEPH JANKUNAS JR. DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2822	OH
2	111N00000X	Chiropractor	X011548	NY

General Provider Information

NPI Number	:	1134104938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD JOSEPH JANKUNAS JR. DC

Provider Business Mailing Address
First Line	:	230 5TH AVE EXT
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1820
Country	:	US
Telephone Number	:	518-773-2000
Fax Number	:	518-773-2663

Provider Business Practice Location Address
First Line	:	230 5TH AVE EXT
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1820
Country	:	US
Telephone Number	:	518-773-2000
Fax Number	:	518-773-2663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	10/22/2010

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