Healthcare Provider Details

I. General information

NPI: 1427065002
Provider Name (Legal Business Name): RYAN A MCDONNEL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 SALEM RUN BLVD SUITE 100
FREDERICKSBURG VA
22407-7119
US

IV. Provider business mailing address

17470 CENTER DR SUITE 4C
RUTHER GLEN VA
22546-2881
US

V. Phone/Fax

Practice location:
  • Phone: 540-786-4882
  • Fax: 540-786-4893
Mailing address:
  • Phone: 804-448-0887
  • Fax: 804-448-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556359
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: