Provider Demographics
NPI:1639251770
Name:BRYAN, CHRISTOPHER T (DC, PA-C)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:T
Last Name:BRYAN
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6741
Mailing Address - Country:US
Mailing Address - Phone:952-460-4550
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6741
Practice Address - Country:US
Practice Address - Phone:952-460-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4416111N00000X
MN1780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor