Provider Demographics
NPI:1790941888
Name:BRYANT, KELLY DUNHAN (DC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DUNHAN
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 1:1124 MOORE ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5931
Mailing Address - Country:US
Mailing Address - Phone:864-525-8476
Mailing Address - Fax:
Practice Address - Street 1:1124 MOORE ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5931
Practice Address - Country:US
Practice Address - Phone:864-525-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U096670281Medicare PIN
570928419Medicare UPIN