Provider Demographics
NPI:1629141627
Name:MEREDITH, BRYAN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:WAYNE
Last Name:MEREDITH
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 1:940 HILLTOP DR STE D
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3869
Mailing Address - Country:US
Mailing Address - Phone:530-223-1228
Mailing Address - Fax:
Practice Address - Street 1:940 HILLTOP DR STE D
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3869
Practice Address - Country:US
Practice Address - Phone:530-221-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01996Medicare UPIN
CADC0273460Medicare ID - Type Unspecified