Provider Demographics
NPI:1104878552
Name:BRYANT, TOM (DC)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:BRYANT
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 1:8933 EWING AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1942
Mailing Address - Country:US
Mailing Address - Phone:847-340-3284
Mailing Address - Fax:
Practice Address - Street 1:5550 TOUHY AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3254
Practice Address - Country:US
Practice Address - Phone:847-329-7501
Practice Address - Fax:847-329-7507
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor