Provider Demographics
NPI:1114942042
Name:BRYSON, JEREMY TODD (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:TODD
Last Name:BRYSON
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 1:12701 RESEARCH BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4386
Mailing Address - Country:US
Mailing Address - Phone:512-250-9799
Mailing Address - Fax:512-250-9836
Practice Address - Street 1:12701 RESEARCH BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4386
Practice Address - Country:US
Practice Address - Phone:512-250-9799
Practice Address - Fax:512-257-3506
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1690257-01Medicaid
610418Medicare ID - Type Unspecified
TX1690257-01Medicaid