Provider Demographics
NPI:1740419761
Name:BRYANT, TIFFANY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ANN
Last Name:BRYANT
Suffix:
Gender:F
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:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-1057
Mailing Address - Country:US
Mailing Address - Phone:620-640-3778
Mailing Address - Fax:
Practice Address - Street 1:711 TAMPA ST
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-9448
Practice Address - Country:US
Practice Address - Phone:620-355-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-12
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor