Provider Demographics
NPI:1497707871
Name:PRYBYLLA, PAULA ELIZABETH (DC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ELIZABETH
Last Name:PRYBYLLA
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 1:99 NAVAHO AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4877
Mailing Address - Country:US
Mailing Address - Phone:507-594-9100
Mailing Address - Fax:256-291-0874
Practice Address - Street 1:99 NAVAHO AVE STE 110
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4877
Practice Address - Country:US
Practice Address - Phone:507-594-9100
Practice Address - Fax:256-291-0874
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002819Medicare ID - Type Unspecified
MNU94082Medicare UPIN