MEDICARE: DR. TYLER RAY VANAKIN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104558037	VA

General Provider Information

NPI Number	:	1548190762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER RAY VANAKIN DC

Provider Business Mailing Address
First Line	:	1507 DODONA TER STE 100
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-4724
Country	:	US
Telephone Number	:	571-388-2346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 DODONA TER STE 100
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-4724
Country	:	US
Telephone Number	:	571-388-2346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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