Provider Demographics
NPI:1497579692
Name:SOARES, BRYCE DANIEL (DC)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:DANIEL
Last Name:SOARES
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 1:1098 E CROSS AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2925
Mailing Address - Country:US
Mailing Address - Phone:559-685-9391
Mailing Address - Fax:
Practice Address - Street 1:1098 E CROSS AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2925
Practice Address - Country:US
Practice Address - Phone:559-685-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor