Provider Demographics
NPI:1285784660
Name:BRYANT, BRADLEY EVANS JR (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:EVANS
Last Name:BRYANT
Suffix:JR
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 1:2317 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9245
Mailing Address - Country:US
Mailing Address - Phone:570-675-1190
Mailing Address - Fax:570-675-5885
Practice Address - Street 1:2317 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9245
Practice Address - Country:US
Practice Address - Phone:570-675-1190
Practice Address - Fax:570-675-5885
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007608L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor