Provider Demographics
NPI:1124231527
Name:SIEGEL, BRYAN R (DC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:R
Last Name:SIEGEL
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:PO BOX 2558
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08862-2558
Mailing Address - Country:US
Mailing Address - Phone:732-376-0606
Mailing Address - Fax:732-376-1614
Practice Address - Street 1:335 MAPLE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4109
Practice Address - Country:US
Practice Address - Phone:732-376-0606
Practice Address - Fax:732-376-1614
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC005239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor