Provider Demographics
NPI:1760557441
Name:BRYAN, SHANNON CLINT (DC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CLINT
Last Name:BRYAN
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 1:227 SPOONER RD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7813
Mailing Address - Country:US
Mailing Address - Phone:406-388-0663
Mailing Address - Fax:406-388-0664
Practice Address - Street 1:227 SPOONER RD
Practice Address - Street 2:SUITE #B
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7813
Practice Address - Country:US
Practice Address - Phone:406-388-0663
Practice Address - Fax:406-388-0664
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0162061Medicaid
MT0162078OtherMEDICAID EPSDT
MT149499OtherNEW WEST HEALTH SERVICES
MT350052048OtherRAILROAD MEDICARE
MT810528339001OtherEBMS OF MONTANA
MT000042151OtherBCBS OF MONTANA
MT810528339001OtherEBMS OF MONTANA
MT000042151OtherBCBS OF MONTANA