Provider Demographics
NPI:1982650255
Name:BRYAN, JOHN F JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:BRYAN
Suffix:JR
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 1:331 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5734
Mailing Address - Country:US
Mailing Address - Phone:843-332-6191
Mailing Address - Fax:843-332-4408
Practice Address - Street 1:331 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5734
Practice Address - Country:US
Practice Address - Phone:843-332-6191
Practice Address - Fax:843-332-4408
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2622Medicaid
SCGCH605Medicaid
SCU87046Medicare UPIN