Provider Demographics
NPI:1144611849
Name:DR BRYAN MOCK LLC
Entity Type:Organization
Organization Name:DR BRYAN MOCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-668-2089
Mailing Address - Street 1:2101 GREENTREE RD
Mailing Address - Street 2:UNIT A-114
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1400
Mailing Address - Country:US
Mailing Address - Phone:412-668-2089
Mailing Address - Fax:412-207-9077
Practice Address - Street 1:2101 GREENTREE RD
Practice Address - Street 2:UNIT A-114
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1400
Practice Address - Country:US
Practice Address - Phone:412-668-2089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007729L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty