Provider Demographics
NPI:1184653032
Name:BRYNGELSON, MARK E (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:BRYNGELSON
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 1:147 GARRISONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1523
Mailing Address - Country:US
Mailing Address - Phone:540-720-6000
Mailing Address - Fax:540-288-1913
Practice Address - Street 1:147 GARRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1523
Practice Address - Country:US
Practice Address - Phone:540-720-6000
Practice Address - Fax:540-288-1913
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010400199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1671414OtherTAX ID
1508133323OtherMEDICARE NPI