Provider Demographics
NPI:1497284368
Name:TODD, BRYANT JOSEPH
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:JOSEPH
Last Name:TODD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 E STATE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2589
Mailing Address - Country:US
Mailing Address - Phone:801-642-4199
Mailing Address - Fax:
Practice Address - Street 1:456 E STATE RD STE 500
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2589
Practice Address - Country:US
Practice Address - Phone:801-642-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10234865-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor