Provider Demographics
NPI:1003975491
Name:BRYANT, RANDY S (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:S
Last Name:BRYANT
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 1:705 141ST PL NE # C4
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4752
Mailing Address - Country:US
Mailing Address - Phone:425-890-6385
Mailing Address - Fax:425-412-4949
Practice Address - Street 1:12443 BEL RED RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2534
Practice Address - Country:US
Practice Address - Phone:425-890-0142
Practice Address - Fax:425-412-4949
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor