Provider Demographics
NPI:1669657003
Name:RUNYAN-VU, DEBORAH (DC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:RUNYAN-VU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12932 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4220
Mailing Address - Country:US
Mailing Address - Phone:909-591-1300
Mailing Address - Fax:909-591-1377
Practice Address - Street 1:12932 10TH ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4220
Practice Address - Country:US
Practice Address - Phone:909-591-1300
Practice Address - Fax:909-591-1377
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30684OtherSTATE LICENSE #