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General NPI Number Information
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NPI Number | 1043499403
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Entity Type | Organization
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Legal Business Name | RUNYON SPECIFIC CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 1448 DIEDERICH BLVD
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City | RUSSELL
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State | KY
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Zip | 41169-1719
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Country | US
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Telephone | 606-833-9355
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Fax | 606-833-1895
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Provider Business Mailing Address
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Address Line | PO BOX 741
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City | ASHLAND
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State | KY
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Zip | 41105-0741
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Country | US
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Telephone | 606-833-9355
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Fax | 606-833-1895
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JASON WAYNE RUNYON
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Credential | D.C.
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Telephone | 606-833-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4816
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License Number State | KY
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