Provider Demographics
NPI:1275655169
Name:RUNGE, RJ REED (DC)
Entity Type:Individual
Prefix:DR
First Name:RJ
Middle Name:REED
Last Name:RUNGE
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 1:1000 CORPORATE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4859
Mailing Address - Country:US
Mailing Address - Phone:636-327-4446
Mailing Address - Fax:636-327-0446
Practice Address - Street 1:1000 CORPORATE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4859
Practice Address - Country:US
Practice Address - Phone:636-327-4446
Practice Address - Fax:636-327-0446
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002025276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO129482OtherGHP
MO168964OtherBLUE CROSS BLUE SHIELD
MO515261OtherHEALTHLINK
MOU93828Medicare UPIN
MO00032239Medicare ID - Type Unspecified