Provider Demographics
NPI:1710052055
Name:BRYER CHIROPRACTIC TR
Entity Type:Organization
Organization Name:BRYER CHIROPRACTIC TR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TTEE
Authorized Official - Prefix:
Authorized Official - First Name:ADELFRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-854-7447
Mailing Address - Street 1:CO197 NORTH MAIN STREET
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:12865-0007
Mailing Address - Country:US
Mailing Address - Phone:518-854-7447
Mailing Address - Fax:518-854-7448
Practice Address - Street 1:CO 197 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NY
Practice Address - Zip Code:12865-0007
Practice Address - Country:US
Practice Address - Phone:518-854-7447
Practice Address - Fax:518-854-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty