Provider Demographics
NPI:1841748662
Name:GINGRAS, BRYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:BRYNNE
Middle Name:
Last Name:GINGRAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 E HIGHWAY 20
Mailing Address - Street 2:STE 207
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-7700
Mailing Address - Country:US
Mailing Address - Phone:850-897-1177
Mailing Address - Fax:850-897-1377
Practice Address - Street 1:210 DESTINY DR
Practice Address - Street 2:
Practice Address - City:GRAY COURT
Practice Address - State:SC
Practice Address - Zip Code:29645-6880
Practice Address - Country:US
Practice Address - Phone:434-229-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4039111N00000X
NC4607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor