Provider Demographics
NPI:1982755963
Name:BRYDGES, DARIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:JOHN
Last Name:BRYDGES
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 1:3046 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1116
Mailing Address - Country:US
Mailing Address - Phone:716-695-5767
Mailing Address - Fax:716-695-5768
Practice Address - Street 1:3046 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1116
Practice Address - Country:US
Practice Address - Phone:716-695-5767
Practice Address - Fax:716-695-5768
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT93471Medicare UPIN
NY12072BMedicare ID - Type UnspecifiedMEDICARE NUMBER