Provider Demographics
NPI:1598890220
Name:GREGORY, BRYAN LARRY (DC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:LARRY
Last Name:GREGORY
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 1:22019 HWY 99
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8023
Mailing Address - Country:US
Mailing Address - Phone:425-659-2411
Mailing Address - Fax:425-672-7065
Practice Address - Street 1:22019 HWY 99
Practice Address - Street 2:SUITE A
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8023
Practice Address - Country:US
Practice Address - Phone:425-659-2411
Practice Address - Fax:425-672-7065
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH34357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor