Provider Demographics
NPI:1932143187
Name:REGIEC, BRYAN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JOSEPH
Last Name:REGIEC
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 1:19612 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-8434
Mailing Address - Country:US
Mailing Address - Phone:440-572-2225
Mailing Address - Fax:440-572-2228
Practice Address - Street 1:19612 W 130TH ST
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-8434
Practice Address - Country:US
Practice Address - Phone:440-572-2225
Practice Address - Fax:440-572-2228
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2382621Medicaid
OH4087533Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
OH2382621Medicaid
OHU90978Medicare UPIN