Healthcare Provider Details

I. General information

NPI: 1841116076
Provider Name (Legal Business Name): BRYAN DECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 CANYON ST
FREDERICK CO
80504-5640
US

IV. Provider business mailing address

3724 JEFFERSON ST STE 104
AUSTIN TX
78731-6204
US

V. Phone/Fax

Practice location:
  • Phone: 276-971-0956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: