NPIMap

Organization Active NPI

Renegade Performance LLC

  • Chiropractor
  • Sayre, PA
National Provider Identifier
1952846719
Registry record updated Jan 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC011215 Issued in PA
Legal business name
RENEGADE PERFORMANCE LLC
Practice address
3226 Elmira St
Sayre, PA 18840-2670
Phone
(607) 765-3281
NPI assigned
Jan 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2017

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

Authorized official

Name
Dr. Ryan Anthony Mullen, D.C.
Title
Owner
Phone
(607) 765-3281

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DC011215 PA Primary

Addresses

Primary practice location

3226 Elmira St
Sayre, PA 18840-2670

Mailing address

413 Seneca St
Sayre, PA 18840-1742
Phone (607) 765-3281

National Provider Directory

National Provider Directory
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.

Locations

3226 Elmira St
Sayre, PA 18840
Phone (607) 765-3281

NPI Registry JSON

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

{
    "created_epoch": "1483401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483401600000",
    "number": "1952846719",
    "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": "3226 ELMIRA ST",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188402670",
            "telephone_number": "607-765-3281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEGADE PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-03",
        "last_updated": "2017-01-03",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "ANTHONY",
        "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": []
}

Other providers in Sayre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.