Provider Demographics
NPI:1275807836
Name:BRYANT CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:BRYANT CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:640-620-3778
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:711 TAMPA ST.
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-1057
Mailing Address - Country:US
Mailing Address - Phone:620-640-3778
Mailing Address - Fax:
Practice Address - Street 1:711 TAMPA ST
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-9448
Practice Address - Country:US
Practice Address - Phone:620-640-3778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty