Provider Demographics
NPI:1801943113
Name:ARDIS, BRYAN R (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R
Last Name:ARDIS
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 1:1103 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5130
Mailing Address - Country:US
Mailing Address - Phone:865-681-4111
Mailing Address - Fax:865-681-4330
Practice Address - Street 1:1103 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5130
Practice Address - Country:US
Practice Address - Phone:865-681-4111
Practice Address - Fax:865-681-4330
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1C 3973273Medicare PIN
TNV03030Medicare UPIN