Provider Demographics
NPI:1679617344
Name:RUNYON, JASON W (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:RUNYON
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:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0741
Mailing Address - Country:US
Mailing Address - Phone:606-833-9355
Mailing Address - Fax:606-833-1895
Practice Address - Street 1:2412 ARGILLITE RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1996
Practice Address - Country:US
Practice Address - Phone:606-833-9355
Practice Address - Fax:606-833-1895
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2634242Medicaid
KY85003416Medicaid
KY000000336562OtherBLUE CROSS BLUE SHIELD
KY9337Medicare PIN
KYDD0962Medicare PIN