Provider Demographics
NPI:1417312919
Name:BRYANT, TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1014 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2431
Mailing Address - Country:US
Mailing Address - Phone:501-843-7247
Mailing Address - Fax:501-843-7360
Practice Address - Street 1:1014 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2431
Practice Address - Country:US
Practice Address - Phone:501-843-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor