Provider Demographics
NPI:1700652468
Name:KRYSHAK, KAYTLYN (DC)
Entity Type:Individual
Prefix:
First Name:KAYTLYN
Middle Name:
Last Name:KRYSHAK
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 1:21785 FILIGREE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6214
Mailing Address - Country:US
Mailing Address - Phone:704-724-9899
Mailing Address - Fax:
Practice Address - Street 1:21785 FILIGREE CT STE 200
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6214
Practice Address - Country:US
Practice Address - Phone:704-724-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor