Provider Demographics
NPI:1306151493
Name:BRYANT CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:BRYANT CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TREATING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-837-8111
Mailing Address - Street 1:1600 SPARKMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1114
Mailing Address - Country:US
Mailing Address - Phone:256-837-8111
Mailing Address - Fax:256-837-6200
Practice Address - Street 1:1600 SPARKMAN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1114
Practice Address - Country:US
Practice Address - Phone:256-837-8111
Practice Address - Fax:256-837-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2308111N00000X
AL1180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty