Provider Demographics
NPI:1134104938
Name:JANKUNAS, RICHARD JOSEPH JR (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:JANKUNAS
Suffix:JR
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 1:230 5TH AVE EXT
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1820
Mailing Address - Country:US
Mailing Address - Phone:518-773-2000
Mailing Address - Fax:518-773-2663
Practice Address - Street 1:230 5TH AVE EXT
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1820
Practice Address - Country:US
Practice Address - Phone:518-773-2000
Practice Address - Fax:518-773-2663
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2822111N00000X
NYX011548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81751Medicare UPIN
OH4032112Medicare ID - Type Unspecified