Provider Demographics
NPI:1982736237
Name:STYNCHULA, ANDREW M (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:STYNCHULA
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 1:8704 LEE HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2104
Mailing Address - Country:US
Mailing Address - Phone:703-204-1220
Mailing Address - Fax:703-991-2515
Practice Address - Street 1:8704 LEE HWY
Practice Address - Street 2:SUITE 03
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2104
Practice Address - Country:US
Practice Address - Phone:703-204-1220
Practice Address - Fax:703-991-2515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA282681OtherBLUE CROSS BLUE SHIELD
VA54-1880604OtherFEDERAL TAX ID NUMBER
VA282681OtherBLUE CROSS BLUE SHIELD