Provider Demographics
NPI:1639502370
Name:ADVANTAGE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC PLLC
Other - Org Name:ADVANTAGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:REAGAN
Authorized Official - Last Name:RUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-720-7777
Mailing Address - Street 1:1003 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2044
Mailing Address - Country:US
Mailing Address - Phone:304-720-7777
Mailing Address - Fax:304-720-7779
Practice Address - Street 1:1003 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2044
Practice Address - Country:US
Practice Address - Phone:304-720-7777
Practice Address - Fax:304-720-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty