Provider Demographics
NPI:1326744772
Name:BRYAN, RYA (DC)
Entity Type:Individual
Prefix:DR
First Name:RYA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36030 EW 1140
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-6213
Mailing Address - Country:US
Mailing Address - Phone:816-441-2876
Mailing Address - Fax:
Practice Address - Street 1:3946 N KICKAPOO AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1711
Practice Address - Country:US
Practice Address - Phone:405-308-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor