Provider Demographics
NPI:1508681495
Name:BRYAN, MADISEN (DC)
Entity type:Individual
Prefix:
First Name:MADISEN
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MADISEN
Other - Middle Name:
Other - Last Name:TRETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:102 SHEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-3108
Mailing Address - Country:US
Mailing Address - Phone:724-831-7335
Mailing Address - Fax:
Practice Address - Street 1:3313 MEMORIAL PKWY SW STE 121
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5315
Practice Address - Country:US
Practice Address - Phone:256-804-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor