Healthcare Provider Details

I. General information

NPI: 1710368600
Provider Name (Legal Business Name): RUNNELS CHIROPRACTIC NORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15510 STATE AVE STE 10B
BASEHOR KS
66007-7114
US

IV. Provider business mailing address

15510 STATE AVE STE 10B
BASEHOR KS
66007-7114
US

V. Phone/Fax

Practice location:
  • Phone: 913-728-2374
  • Fax: 913-728-2384
Mailing address:
  • Phone: 913-728-2374
  • Fax: 913-728-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05687
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SCOTT ALAN RUNNELS
Title or Position: OWNER/OPERATOR
Credential: D.C.
Phone: 913-728-2374