Provider Demographics
NPI:1164869921
Name:JOHNSON, BRYAN ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ANDREW
Last Name:JOHNSON
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 1:414 MCMURRAY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1132
Mailing Address - Country:US
Mailing Address - Phone:412-833-7246
Mailing Address - Fax:412-833-7250
Practice Address - Street 1:414 MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1132
Practice Address - Country:US
Practice Address - Phone:412-833-7246
Practice Address - Fax:412-833-7250
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor