Provider Demographics
NPI:1588662563
Name:LYKENS, RONDA NICHOLE (DC)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:NICHOLE
Last Name:LYKENS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 VALLEY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6455
Mailing Address - Country:US
Mailing Address - Phone:540-667-7388
Mailing Address - Fax:540-667-4694
Practice Address - Street 1:2433 VALLEY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6455
Practice Address - Country:US
Practice Address - Phone:540-667-7388
Practice Address - Fax:540-667-4694
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000300446Medicaid
VA3500 1179Medicare PIN
VA000300446Medicaid