Provider Demographics
NPI:1821105735
Name:BARRY, BRYAN WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:WADE
Last Name:BARRY
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 1:2821 OLD DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3138
Mailing Address - Country:US
Mailing Address - Phone:203-288-2821
Mailing Address - Fax:203-288-2854
Practice Address - Street 1:2821 OLD DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3138
Practice Address - Country:US
Practice Address - Phone:203-288-2821
Practice Address - Fax:203-288-2854
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor