Provider Demographics
NPI:1942750807
Name:CALL, BRYAN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:THOMAS
Last Name:CALL
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 1:9 BURNING EMBER LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8810
Mailing Address - Country:US
Mailing Address - Phone:208-757-8889
Mailing Address - Fax:
Practice Address - Street 1:841 CHICKADEE DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4770
Practice Address - Country:US
Practice Address - Phone:208-757-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor