Provider Demographics
NPI:1225133028
Name:UNRUH, SIDNEY ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:ALLEN
Last Name:UNRUH
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 1:1015 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-2942
Mailing Address - Country:US
Mailing Address - Phone:785-899-2225
Mailing Address - Fax:785-890-5596
Practice Address - Street 1:1015 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-2942
Practice Address - Country:US
Practice Address - Phone:785-899-2225
Practice Address - Fax:785-890-5596
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4627111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060444Medicare ID - Type Unspecified
KSU75632Medicare UPIN