Healthcare Provider Details

I. General information

NPI: 1841560489
Provider Name (Legal Business Name): JOSIAH PHILIP RYABINOV D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21020 SYCOLIN RD STE 145
ASHBURN VA
20147-4040
US

IV. Provider business mailing address

PO BOX 700688
SAN ANTONIO TX
78270-0688
US

V. Phone/Fax

Practice location:
  • Phone: 800-404-6050
  • Fax: 866-313-3397
Mailing address:
  • Phone: 800-404-6050
  • Fax: 866-313-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556946
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number0104556946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: