Provider Demographics
NPI:1497856538
Name:BRYANT-BENSON, CHRISTIE MAE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:MAE
Last Name:BRYANT-BENSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRISTIE
Other - Middle Name:MAE
Other - Last Name:BRYANT-BENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1301 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2107
Mailing Address - Country:US
Mailing Address - Phone:803-201-4282
Mailing Address - Fax:
Practice Address - Street 1:1301 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2107
Practice Address - Country:US
Practice Address - Phone:803-888-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3390111N00000X
NYX010849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3390OtherSC DC LICENSE
NY629920OtherAETNA
NYPO10010849OtherBLUE CHOICE
NY175965ANOtherPREFERRED CARE
NY9416263OtherPHCS
NYPO20010849OtherBLUE CROSS/BLUE SHIELD
NY629920OtherAETNA
NY9416263OtherPHCS