Provider Demographics
NPI:1376168781
Name:HOME RUN CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:HOME RUN CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOOKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-358-5625
Mailing Address - Street 1:12 NEMESIA CT E
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5736
Mailing Address - Country:US
Mailing Address - Phone:352-358-5625
Mailing Address - Fax:
Practice Address - Street 1:12 NEMESIA CT E
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5736
Practice Address - Country:US
Practice Address - Phone:352-358-5625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health