Provider Demographics
NPI:1104021435
Name:BRYAN CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:BRYAN CHIROPRACTIC, P.A.
Other - Org Name:HEALTHQUEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TAD
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-292-9247
Mailing Address - Street 1:1053 GRAND AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3022
Mailing Address - Country:US
Mailing Address - Phone:651-292-9247
Mailing Address - Fax:651-292-9257
Practice Address - Street 1:1053 GRAND AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3022
Practice Address - Country:US
Practice Address - Phone:651-292-9247
Practice Address - Fax:651-292-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4416111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty