Provider Demographics
NPI:1649463308
Name:VANBECELAERE, BRYAN RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:RAYMOND
Last Name:VANBECELAERE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRYAN
Other - Middle Name:RAYMOND
Other - Last Name:VANBECELAERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 6094
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29606-6094
Mailing Address - Country:US
Mailing Address - Phone:864-325-0407
Mailing Address - Fax:
Practice Address - Street 1:2718 WADE HAMPTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1165
Practice Address - Country:US
Practice Address - Phone:864-325-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor