Provider Demographics
NPI:1285229120
Name:HARRISON, BRYCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:HARRISON
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 1:1973 W 33RD ST # 110
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3875
Mailing Address - Country:US
Mailing Address - Phone:405-673-5339
Mailing Address - Fax:
Practice Address - Street 1:14901 N KELLY AVE STE 101
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3884
Practice Address - Country:US
Practice Address - Phone:405-673-5339
Practice Address - Fax:405-509-6812
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor