Provider Demographics
NPI:1710044797
Name:STEWART, BRYAN R R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R R
Last Name:STEWART
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 1:400 SUNSET AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020
Mailing Address - Country:US
Mailing Address - Phone:425-670-3636
Mailing Address - Fax:
Practice Address - Street 1:6739 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5508
Practice Address - Country:US
Practice Address - Phone:206-781-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003296111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology