Provider Demographics
NPI:1801912043
Name:AURORA RAINBOW ENTERPRISES INC
Entity type:Organization
Organization Name:AURORA RAINBOW ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-254-1969
Mailing Address - Street 1:514 S NOLAND RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-3969
Mailing Address - Country:US
Mailing Address - Phone:816-254-1969
Mailing Address - Fax:816-254-1972
Practice Address - Street 1:514 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-3969
Practice Address - Country:US
Practice Address - Phone:816-254-1969
Practice Address - Fax:816-254-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U39171Medicare UPIN
R560000Medicare ID - Type Unspecified
R565764Medicare ID - Type Unspecified