Provider Demographics
NPI:1609839000
Name:PRYMAK, DAVID JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:PRYMAK
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 1:13104 FOXHALL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4806
Mailing Address - Country:US
Mailing Address - Phone:703-680-0991
Mailing Address - Fax:
Practice Address - Street 1:12801 DARBY BROOK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2497
Practice Address - Country:US
Practice Address - Phone:703-494-9922
Practice Address - Fax:703-494-8403
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA211330OtherBLUE CROSS BLUE SHIELD
VA350000780Medicare ID - Type Unspecified
VA211330OtherBLUE CROSS BLUE SHIELD