Provider Demographics
NPI:1013929363
Name:BRYAN, RICHARD KARL (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KARL
Last Name:BRYAN
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 1:2105 N SOUTHPORT AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4069
Mailing Address - Country:US
Mailing Address - Phone:773-472-0560
Mailing Address - Fax:773-472-0429
Practice Address - Street 1:2105 N SOUTHPORT AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4069
Practice Address - Country:US
Practice Address - Phone:773-472-0560
Practice Address - Fax:773-472-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic