Healthcare Provider Details

I. General information

NPI: 1013929363
Provider Name (Legal Business Name): RICHARD KARL BRYAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 N SOUTHPORT AVE SUITE #208
CHICAGO IL
60614-4069
US

IV. Provider business mailing address

2105 N SOUTHPORT AVE SUITE #208
CHICAGO IL
60614-4069
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-0560
  • Fax: 773-472-0429
Mailing address:
  • Phone: 773-472-0560
  • Fax: 773-472-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: