Provider Demographics
NPI:1730851619
Name:DURBANO, RILEY (DC, ATC)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:DURBANO
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OLDE GREENWICH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4063
Mailing Address - Country:US
Mailing Address - Phone:540-395-5985
Mailing Address - Fax:540-380-0064
Practice Address - Street 1:150 OLDE GREENWICH DR STE 100
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4063
Practice Address - Country:US
Practice Address - Phone:540-395-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260037072255A2300X
VA0104-557805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer