Provider Demographics
NPI:1104860766
Name:MCDONALD, BRYAN H (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:H
Last Name:MCDONALD
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 1:1800 MCFARLAND BLVD E,
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5882
Mailing Address - Country:US
Mailing Address - Phone:205-345-8102
Mailing Address - Fax:205-263-6478
Practice Address - Street 1:1800 MCFARLAND BLVD E,
Practice Address - Street 2:SUITE 340
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5882
Practice Address - Country:US
Practice Address - Phone:205-345-8102
Practice Address - Fax:205-263-6478
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51527164OtherBLUE CROSS BLUE SHIELD
AL51527164OtherBLUE CROSS BLUE SHIELD
ALU98775Medicare UPIN