| |
17470 Center Dr, Suite 4c, Ruther Glen, VA 22546-2881 | |
(804) 448-0887 | |
(804) 448-0887 |
Full Name | |
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Type | Facility |
Speciality | Chiropractor |
Location | 17470 Center Dr, Ruther Glen, Virginia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1053640730 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | 0104556359 (Virginia) | Primary |
Provider Name | Ryan A Mcdonnel |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1427065002 PECOS PAC ID: 2365475571 Enrollment ID: I20050916000689 |
Mailing Address | Practice Location Address |
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17470 Center Dr, Suite 4c, Ruther Glen, VA 22546-2881 Ph: (804) 448-0887 | 17470 Center Dr, Suite 4c, Ruther Glen, VA 22546-2881 Ph: (804) 448-0887 |