Provider Demographics
NPI:1497808471
Name:KALODISH, BRYAN HARRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:HARRIS
Last Name:KALODISH
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 1:970 5TH AVE N
Mailing Address - Street 2:970 5TH AVE NORTH
Mailing Address - City:NAPLES, FL 34102
Mailing Address - State:FL
Mailing Address - Zip Code:34102
Mailing Address - Country:US
Mailing Address - Phone:239-692-8160
Mailing Address - Fax:239-331-4148
Practice Address - Street 1:970 5TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5817
Practice Address - Country:US
Practice Address - Phone:239-692-8160
Practice Address - Fax:239-331-4148
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007076111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU67507Medicare UPIN
FL55379YMedicare PIN
FL00055379Medicare ID - Type UnspecifiedMEDICARE ISSUED NUMBER