Provider Demographics
NPI:1477154334
Name:RUMEDI, SILVARAY WINDITYAS (DC)
Entity Type:Individual
Prefix:
First Name:SILVARAY
Middle Name:WINDITYAS
Last Name:RUMEDI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44330 PREMIER PLZ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5070
Mailing Address - Country:US
Mailing Address - Phone:240-272-2702
Mailing Address - Fax:
Practice Address - Street 1:44330 PREMIER PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5070
Practice Address - Country:US
Practice Address - Phone:240-272-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor