Provider Demographics
NPI:1306854625
Name:UNRUH, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
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 1:302 N 8TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3738
Mailing Address - Country:US
Mailing Address - Phone:479-621-9006
Mailing Address - Fax:479-621-9497
Practice Address - Street 1:302 N 8TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3738
Practice Address - Country:US
Practice Address - Phone:479-621-9006
Practice Address - Fax:479-621-9497
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART43949Medicare UPIN
AR59177Medicare ID - Type Unspecified