Provider Demographics
NPI:1134111438
Name:RUNNE, EUGENE PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:PETER
Last Name:RUNNE
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 1:520 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4712
Mailing Address - Country:US
Mailing Address - Phone:865-982-6321
Mailing Address - Fax:865-681-1875
Practice Address - Street 1:520 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4712
Practice Address - Country:US
Practice Address - Phone:865-982-6321
Practice Address - Fax:865-681-1875
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 528111N00000X
GA6057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2004075OtherBCBS
TNUPIN T74655Medicare ID - Type Unspecified