Healthcare Provider Details

I. General information

NPI: 1124073754
Provider Name (Legal Business Name): ONION RIVER CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MAIN ST
WINOOSKI VT
05404-1338
US

IV. Provider business mailing address

440 MAIN ST
WINOOSKI VT
05404-1338
US

V. Phone/Fax

Practice location:
  • Phone: 802-655-0354
  • Fax: 802-655-0354
Mailing address:
  • Phone: 802-655-0354
  • Fax: 802-655-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0060000944
License Number StateVT

VIII. Authorized Official

Name: DR. KELLY RYBICKI
Title or Position: OWNER/PRESIDIENT
Credential: D.C.
Phone: 802-655-0354