Provider Demographics
NPI:1356463178
Name:RUNYAN, CLAY STUART (DC)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:STUART
Last Name:RUNYAN
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 1:1109 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1424
Mailing Address - Country:US
Mailing Address - Phone:605-642-7111
Mailing Address - Fax:605-644-1334
Practice Address - Street 1:1109 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1424
Practice Address - Country:US
Practice Address - Phone:605-642-7111
Practice Address - Fax:605-644-1334
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0080135OtherBCBS WELLMARK
SD7603220Medicaid
SD580135Medicare ID - Type Unspecified