Provider Demographics
NPI:1710487756
Name:RUNYAN, KIMBRA NICOLE
Entity Type:Individual
Prefix:DR
First Name:KIMBRA
Middle Name:NICOLE
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 COMSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-3811
Mailing Address - Country:US
Mailing Address - Phone:847-691-2727
Mailing Address - Fax:
Practice Address - Street 1:1607 E MAIN ST STE 2A
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2390
Practice Address - Country:US
Practice Address - Phone:331-222-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor