Provider Demographics
NPI:1093793069
Name:PRUNTY, JOHN W (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:PRUNTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7006
Mailing Address - Country:US
Mailing Address - Phone:605-996-2186
Mailing Address - Fax:605-996-2187
Practice Address - Street 1:708 E KAY AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4524
Practice Address - Country:US
Practice Address - Phone:605-996-2186
Practice Address - Fax:605-996-2187
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS8598Medicare ID - Type Unspecified
SDU88531Medicare UPIN