Provider Demographics
NPI:1558403014
Name:BRYNGELSON, PAUL S (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:BRYNGELSON
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 1:8180 DREAM ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7560
Mailing Address - Country:US
Mailing Address - Phone:859-647-7950
Mailing Address - Fax:859-647-7950
Practice Address - Street 1:8180 DREAM ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7560
Practice Address - Country:US
Practice Address - Phone:859-647-7950
Practice Address - Fax:859-647-7950
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001253Medicaid