Organization
RENEGADE PERFORMANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN MULLEN D.C. (OWNER)
(607) 765-3281
Entity
Organization
Contact information
Practice address
418 S KEYSTONE AVE, SAYRE, PA 18840-1553
(570) 886-0385
Mailing address
413 SENECA ST, SAYRE, PA 18840-1742
(607) 765-3281
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC011215
PA
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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