Provider Demographics
NPI:1205105301
Name:PRYMAK CHIROPRACTIC, PC
Entity type:Organization
Organization Name:PRYMAK CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PRYMAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-494-9922
Mailing Address - Street 1:12801 DARBY BROOK CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2497
Mailing Address - Country:US
Mailing Address - Phone:703-494-9922
Mailing Address - Fax:703-494-8403
Practice Address - Street 1:12801 DARBY BROOK CT
Practice Address - Street 2:SUITE 102
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA211330OtherANTHEM BLUE CROSS BLUE SHIELD
VA211330OtherANTHEM BLUE CROSS BLUE SHIELD