Provider Demographics
NPI:1104031491
Name:RUNNERSTRUM, ALANA AMBER (DC)
Entity Type:Individual
Prefix:DR
First Name:ALANA
Middle Name:AMBER
Last Name:RUNNERSTRUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 TRAFFIC WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3333
Mailing Address - Country:US
Mailing Address - Phone:805-481-9191
Mailing Address - Fax:805-481-9192
Practice Address - Street 1:104 TRAFFIC WAY
Practice Address - Street 2:SUITE B
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3333
Practice Address - Country:US
Practice Address - Phone:805-481-9191
Practice Address - Fax:805-481-9192
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN230460AMedicare UPIN