Provider Demographics
NPI:1689211781
Name:HOLLINGSHEAD, RYAN EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWIN
Last Name:HOLLINGSHEAD
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 1:208 FOX HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1780
Mailing Address - Country:US
Mailing Address - Phone:757-850-0500
Mailing Address - Fax:
Practice Address - Street 1:208 FOX HILL RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1780
Practice Address - Country:US
Practice Address - Phone:757-850-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor