Healthcare Provider Details

I. General information

NPI: 1477917540
Provider Name (Legal Business Name): MATTHEW KAIRYS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44330 PREMIER PLZ SUITE #110A
ASHBURN VA
20147-5070
US

IV. Provider business mailing address

44330 PREMIER PLZ SUITE #110A
ASHBURN VA
20147-5070
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9355
  • Fax:
Mailing address:
  • Phone: 703-723-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104-557329
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: