Provider Demographics
NPI:1992084354
Name:BRYAN ROAD CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:BRYAN ROAD CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HANKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-620-6939
Mailing Address - Street 1:11029 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1254
Mailing Address - Country:US
Mailing Address - Phone:314-620-6939
Mailing Address - Fax:
Practice Address - Street 1:11029 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-1254
Practice Address - Country:US
Practice Address - Phone:314-620-6939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
261995637Medicare PIN