Provider Demographics
NPI:1013243245
Name:DOUGLAS, BRYAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DAVID
Last Name:DOUGLAS
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 1:1550 SE WILSHIRE PL APT 103
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5780
Mailing Address - Country:US
Mailing Address - Phone:772-834-9467
Mailing Address - Fax:
Practice Address - Street 1:778 S US 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-4701
Practice Address - Country:US
Practice Address - Phone:772-567-4661
Practice Address - Fax:772-567-4641
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor