Provider Demographics
NPI:1013682954
Name:EMRYS, BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:EMRYS
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 1:107 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-2128
Mailing Address - Country:US
Mailing Address - Phone:815-942-8399
Mailing Address - Fax:815-942-8388
Practice Address - Street 1:107 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2128
Practice Address - Country:US
Practice Address - Phone:815-942-8399
Practice Address - Fax:815-942-8388
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038013741OtherSTATE OF IL