Provider Demographics
NPI:1598837817
Name:UNRUH, WALLY RAY (MD)
Entity type:Individual
Prefix:DR
First Name:WALLY
Middle Name:RAY
Last Name:UNRUH
Suffix:
Gender:M
Credentials:MD
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 475
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-0475
Mailing Address - Country:US
Mailing Address - Phone:303-688-8822
Mailing Address - Fax:303-688-8830
Practice Address - Street 1:901 PARK ST # B
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-1527
Practice Address - Country:US
Practice Address - Phone:303-688-8822
Practice Address - Fax:303-688-8830
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor