Provider Demographics
NPI:1124027800
Name:OKLAND, BRYAN
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:OKLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2502
Mailing Address - Country:US
Mailing Address - Phone:218-749-5436
Mailing Address - Fax:218-749-2118
Practice Address - Street 1:102 1ST ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2502
Practice Address - Country:US
Practice Address - Phone:218-749-5436
Practice Address - Fax:218-749-2118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN278M1OKOtherBCBS PROVIDER #
MN277M9OKOtherBCBS GROUP #
MNC03529Medicare ID - Type UnspecifiedPROVIDER #