Provider Demographics
NPI:1427065002
Name:MCDONNEL, RYAN A (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:MCDONNEL
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 1:17470 CENTER DR
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-2881
Mailing Address - Country:US
Mailing Address - Phone:804-448-0887
Mailing Address - Fax:804-448-0887
Practice Address - Street 1:5705 SALEM RUN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7119
Practice Address - Country:US
Practice Address - Phone:540-786-4882
Practice Address - Fax:540-786-4893
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556359OtherVA STATE LICENSE NUMBER