Provider Demographics
NPI:1336388305
Name:GUNYAN FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:GUNYAN FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CSCS
Authorized Official - Phone:970-250-2889
Mailing Address - Street 1:456 KOKOPELLI BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-8723
Mailing Address - Country:US
Mailing Address - Phone:970-250-2889
Mailing Address - Fax:
Practice Address - Street 1:456 KOKOPELLI BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-8723
Practice Address - Country:US
Practice Address - Phone:970-250-2889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1700021524OtherINDIVIDUAL NPI NUMBER