Provider Demographics
NPI:1609186626
Name:VIRGIL BRYANT MANAGEMENT
Entity Type:Organization
Organization Name:VIRGIL BRYANT MANAGEMENT
Other - Org Name:BRYANT CLINICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPWNER/DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-367-2567
Mailing Address - Street 1:800 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3536
Mailing Address - Country:US
Mailing Address - Phone:337-367-2567
Mailing Address - Fax:337-367-2578
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3536
Practice Address - Country:US
Practice Address - Phone:337-367-2567
Practice Address - Fax:337-367-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548237001OtherBLUE CROSS BLUE SHILED OF LA
LA1548237001Medicare PIN