=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174064661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN SILBERNICK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2017
-----------------------------------------------------
Last Update Date | 03/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5005 TEXAS ST STE 101
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-3722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-518-4222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5005 TEXAS ST STE 101
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-3722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-518-4222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. RYAN SILBERNICK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 218-579-0048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 33816
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------