Individual provider Active NPI

Jeremy Todd Bryson, D.C.

  • Chiropractor
  • Austin, TX
National Provider Identifier
1114942042
Registry record updated Jun 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
9599 Issued in TX
Practice address
12701 Research Blvd
Suite 309
Austin, TX 78759-4386
Phone
(512) 250-9799
Fax
(512) 257-3506
NPI assigned
Jul 13, 2006
Last updated
Jun 20, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 9599 TX Primary

Addresses

Primary practice location

12701 Research Blvd
Suite 309
Austin, TX 78759-4386

Mailing address

12701 Research Blvd
Suite 309
Austin, TX 78759-4386
Phone (512) 250-9799

Other identifiers 1

IdentifierTypeStateIssuer
1690257-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9599TXMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sports and Wellness Chiropractic Solutions, L.L.C. Chiropractor Past Accepting new patients
Earnest Holistic Health Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403222400000",
    "number": "1114942042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12701 RESEARCH BLVD",
            "address_2": "SUITE 309",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787594386",
            "telephone_number": "512-250-9799",
            "fax_number": "512-250-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12701 RESEARCH BLVD",
            "address_2": "SUITE 309",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787594386",
            "telephone_number": "512-250-9799",
            "fax_number": "512-257-3506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYSON",
        "first_name": "JEREMY",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2014-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "9599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1690257-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.