Runyon Specific Chiropractic, LLC
Organization Active NPI Chiropractor · Russell, KY
NPI 1043499403 · NPPES record last updated Nov 7, 2008
Key facts
- NPI
- 1043499403
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4816 (KY)
- Legal business name
- RUNYON SPECIFIC CHIROPRACTIC, LLC
- Practice address
- 1448 Diederich Blvd
Russell, KY 41169-1719 - Phone
- (606) 833-9355
- Fax
- (606) 833-1895
- NPI assigned
- Nov 1, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Jason Wayne Runyon, D.C.
- Title
- Chiropractor
- Phone
- (606) 833-9355
Practitioners 1
-
Jason W Runyon, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040914001248 | KY | Part B Supplier - Clinic/Group Practice | 3971570326 |
Receives reassigned benefits from 1 practitioner Practice locations: Flatwoods, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4816 | KY | Yes |
Addresses
Primary practice location
1448 Diederich Blvd
Russell, KY 41169-1719
Mailing address
PO Box 741
Ashland, KY 41105-0741
Phone (606) 833-9355
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85003416 | Medicaid | KY | |
| 000000336562 | Other | KY | BLUE CROSS BLUE SHIELD |
| 2634242 | Medicaid | OH |
Other providers in Russell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.