Renegade Performance LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC011215 Issued in PA

Legal business name

RENEGADE PERFORMANCE LLC

Practice address

418 S Keystone Ave
Sayre, PA 18840-1553

Phone

(570) 886-0385

NPI assigned

Feb 23, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ryan Mullen, D.C.NPI 1750881710

Title

Owner

Phone

(607) 765-3281

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Tax ID family

Renegade Performance LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Renegade Performance LLC

  • Chiropractor
  • Sayre, PA
  • NPI 1952846719
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan Anthony Mullen, DC

  • Chiropractor
  • Sayre, PA
  • NPI 1750881710
  Medicare reassignment Care Compare group NPD Authorized official
• Holly Snyder, DC, LAC

  • Chiropractor
  • Sayre, PA
  • NPI 1508364688
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487808000000",
    "number": "1568901577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 SENECA ST",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401742",
            "telephone_number": "607-765-3281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 S KEYSTONE AVE",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401553",
            "telephone_number": "570-886-0385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEGADE PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-23",
        "last_updated": "2017-02-23",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "607-765-3281",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC011215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Ratnani, M.D.
• Akshay Parag Raut, M.D.
• Amy Reed
• Russell Eugene Rees, M.D.
• Felice Lynn Reitknecht, M.D.
• Renegade Performance LLC
• Kelly Marie Reynolds, PA
• Julie Lynn Richards, DNP
• Kim L Rickert, MD
• Jennifer Leigh Riley, RN, CDE

• Chiropractor in Sayre, PA
• Providers in Sayre, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.