Provider Demographics
NPI:1104086180
Name:BRYSON CHIROPRACTIC
Entity type:Organization
Organization Name:BRYSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-596-0333
Mailing Address - Street 1:446 RAHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3305
Mailing Address - Country:US
Mailing Address - Phone:732-596-0333
Mailing Address - Fax:732-596-0335
Practice Address - Street 1:446 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3305
Practice Address - Country:US
Practice Address - Phone:732-596-0333
Practice Address - Fax:732-596-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00998900225100000X
NJ40QA00713400225100000X
NJ38MC00510200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0027448Medicaid
NJU68924Medicare UPIN