Provider Demographics
NPI:1528486743
Name:BRYAN EMERSON DC
Entity type:Organization
Organization Name:BRYAN EMERSON DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-395-3845
Mailing Address - Street 1:655 CRAIG RD STE 155
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7173
Mailing Address - Country:US
Mailing Address - Phone:314-755-1097
Mailing Address - Fax:866-497-7496
Practice Address - Street 1:655 CRAIG RD STE 155
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7173
Practice Address - Country:US
Practice Address - Phone:314-755-1097
Practice Address - Fax:866-497-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009000026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty