Provider Demographics
NPI:1235253295
Name:BRYANT, RANDALL DURWOOD (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DURWOOD
Last Name:BRYANT
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 1:1315 SE 25TH LOOP STE 103
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1022
Mailing Address - Country:US
Mailing Address - Phone:352-694-7700
Mailing Address - Fax:
Practice Address - Street 1:1315 SE 25TH LOOP STE 103
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1022
Practice Address - Country:US
Practice Address - Phone:352-694-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55309Medicare ID - Type Unspecified