Active NPI
Mark William Bryan, D.C.
- Chiropractor
- Olympia, WA
National Provider Identifier
1114042074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH00002146
- Practice address
- 2815 Yelm Hwy SE
Olympia, WA 98501-4829 - Phone
- (360) 456-8605
- Fax
- (360) 456-0155
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH00002146 | WA | Primary |
Addresses
Primary practice location
2815 Yelm Hwy SE
Olympia, WA 98501-4829
Mailing address
2815 Yelm Hwy SE
Olympia, WA 98501-4829
Phone (360) 456-8605
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130321000391 | WA | Practitioner - Chiropractic | 3870738842 | Practice locations: Olympia, WA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2146 | WA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114042074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2815 YELM HWY SE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985014829",
"telephone_number": "360-456-8605",
"fax_number": "360-456-0155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2815 YELM HWY SE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985014829",
"telephone_number": "360-456-8605",
"fax_number": "360-456-0155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYAN",
"first_name": "MARK",
"middle_name": "WILLIAM",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "CH00002146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.