Provider Demographics
NPI:1962279919
Name:SYLLA, MOUSSA (DC)
Entity type:Individual
Prefix:
First Name:MOUSSA
Middle Name:
Last Name:SYLLA
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 1:7607 WILDWOOD CT APT B2
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1875
Mailing Address - Country:US
Mailing Address - Phone:443-739-6150
Mailing Address - Fax:
Practice Address - Street 1:7607 WILDWOOD CT APT B2
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1875
Practice Address - Country:US
Practice Address - Phone:443-739-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557862111NI0013X, 111NN1001X, 111N00000X
VA01045578862111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician