Provider Demographics
NPI:1700930971
Name:BRYANT, JAMES TRACY (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TRACY
Last Name:BRYANT
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 1:4519 SHAVANO PEAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5838
Mailing Address - Country:US
Mailing Address - Phone:210-823-9200
Mailing Address - Fax:210-823-9200
Practice Address - Street 1:24165 W IH 10 STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1162
Practice Address - Country:US
Practice Address - Phone:210-698-1700
Practice Address - Fax:210-698-3400
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5416111N00000X
LA814111N00000X
AR1146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4267881OtherAETNA
TX611312OtherUNITED HEALTHCARE
TX606087OtherBLUE CROSS BLUE SHIELD
TX611312OtherUNITED HEALTHCARE
TXT20109Medicare UPIN