MEDICARE: PRODIGY CHIROPRACTIC LLC

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

General Provider Information

NPI Number	:	1205705621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRODIGY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2920 W PARK ROW DR STE 100
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-2054
Country	:	US
Telephone Number	:	817-277-1111
Fax Number	:	817-861-4593

Provider Business Practice Location Address
First Line	:	2920 W PARK ROW DR STE 100
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-2054
Country	:	US
Telephone Number	:	817-277-1111
Fax Number	:	817-861-4593

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. JOSEPH RUANE
Credential	:	DC
Telephone Number	:	817-277-1111

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	01/27/2026

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Directions to “PRODIGY CHIROPRACTIC LLC ” Practice Location

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