Provider Demographics
NPI:1629541743
Name:RYBAR, SAMANTHA NIKOLE (DC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NIKOLE
Last Name:RYBAR
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 1:90 LAKE PINES DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7678
Mailing Address - Country:US
Mailing Address - Phone:248-343-4218
Mailing Address - Fax:
Practice Address - Street 1:50200 DENNIS CT
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2021
Practice Address - Country:US
Practice Address - Phone:248-505-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor