Provider Demographics
NPI:1457473217
Name:FOSS, BRYAN LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LESLIE
Last Name:FOSS
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 1:75 S MADISON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3036
Mailing Address - Country:US
Mailing Address - Phone:303-321-2252
Mailing Address - Fax:303-321-0663
Practice Address - Street 1:155 S MADISON ST STE 324
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3099
Practice Address - Country:US
Practice Address - Phone:303-882-4113
Practice Address - Fax:303-321-0663
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1229111N00000X
CO3541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor