MEDICARE: ONION RIVER CHIROPRACTIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0060000944	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124073754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONION RIVER CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	440 MAIN ST
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-1338
Country	:	US
Telephone Number	:	802-655-0354
Fax Number	:	802-655-0354

Provider Business Practice Location Address
First Line	:	440 MAIN ST
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-1338
Country	:	US
Telephone Number	:	802-655-0354
Fax Number	:	802-655-0354

Authorized Official
Title or Position	:	OWNER/PRESIDIENT
Name	:	DR. KELLY RYBICKI
Credential	:	D.C.
Telephone Number	:	802-655-0354

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	05/15/2009

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Directions to “ONION RIVER CHIROPRACTIC, INC ” Practice Location

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