Bradley E Bryant DC PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC-007608-L Issued in PA

Legal business name

BRADLEY E BRYANT DC PC

Practice address

217 Memorial Hwy
Dallas, PA 18612-1232

Phone

(570) 675-1190

Fax

(570) 675-5885

NPI assigned

Sep 29, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bradley E Bryant Jr., DCNPI 1285784660

Title

President BMCC

Phone

(570) 675-1190

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Back Mountain Chiropractic Center Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bradley Evans Bryant Jr., D.C.

  • Chiropractor
  • Dallas, PA
  • NPI 1285784660
  Medicare reassignment NPD Authorized official
• Michael R Fancher, M.D.

  • Diagnostic Radiology Physician
  • Springfield, MO
  • NPI 1003876681
  NPD (past)
• Sohail Maqbool, MD

  • Diagnostic Radiology Physician
  • Saint Louis, MO
  • NPI 1477507945
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083601702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 MEMORIAL HWY",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186121232",
            "telephone_number": "570-675-1190",
            "fax_number": "570-675-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 MEMORIAL HWY",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186121232",
            "telephone_number": "570-675-1190",
            "fax_number": "570-675-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY E BRYANT DC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT BMCC",
        "authorized_official_telephone_number": "570-675-1190",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC-007608-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "BA881741",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back Mountain Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Biscotto
• Kimberly Ann Bonham, OTR/L
• Linda C Bonk, RPH
• Hans Werner Bottesch, R.PH.
• Sydney Boyd, DPT
• Kara A. Brezinski-Clark, D.O.
• Laurie Brogan, PT, DPT, CEEAA, GCS
• Noell Ann Brooks, DMD
• Anthony Joseph Bruno Jr., DPT
• Bradley Evans Bryant Jr., D.C.

• All providers in Dallas, PA
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.