Provider Demographics
NPI:1801866843
Name:BRYANT, WENDELL (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:
Last Name:BRYANT
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 1:232 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4730
Mailing Address - Country:US
Mailing Address - Phone:870-367-8442
Mailing Address - Fax:870-367-2869
Practice Address - Street 1:232 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4730
Practice Address - Country:US
Practice Address - Phone:870-367-8442
Practice Address - Fax:870-367-2869
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101330718Medicaid
AR101330718Medicaid