Provider Demographics
NPI:1285915876
Name:DANA, BRYAN M (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:M
Last Name:DANA
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 1:97 S MAIN ST # 117
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2526
Mailing Address - Country:US
Mailing Address - Phone:435-465-5009
Mailing Address - Fax:
Practice Address - Street 1:1950 S HIGHWAY 89 STE B
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-4459
Practice Address - Country:US
Practice Address - Phone:435-465-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8207111N00000X
UT13696867-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU83183Medicare UPIN