Provider Demographics
NPI:1255300752
Name:BRYAN, VINCENT EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:EUGENE
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 1:2450 SUNSET POINT RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1516
Mailing Address - Country:US
Mailing Address - Phone:727-799-3319
Mailing Address - Fax:727-799-8859
Practice Address - Street 1:2450 SUNSET POINT RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1516
Practice Address - Country:US
Practice Address - Phone:727-799-3319
Practice Address - Fax:727-799-8859
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT56324Medicare UPIN
FL89741AMedicare ID - Type Unspecified