Provider Demographics
NPI:1467525824
Name:BRYANT, JULIE PETERMANN (D C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:PETERMANN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 W CENTURY AVE
Mailing Address - Street 2:202
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0917
Mailing Address - Country:US
Mailing Address - Phone:701-258-7376
Mailing Address - Fax:
Practice Address - Street 1:1424 W CENTURY AVE
Practice Address - Street 2:202
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0917
Practice Address - Country:US
Practice Address - Phone:701-258-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND502111N00000X
MT604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17417Medicaid
NDBRY12379OtherBLUE CROSS BLUE SHIELD ND
NDU10355OtherWORKFORCE SAFETY & INS
ND12379Medicare ID - Type Unspecified