Healthcare Provider Details

I. General information

NPI: 1902111347
Provider Name (Legal Business Name): LOUISE EDITH BRYANT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FRONT ST
BATH ME
04530-2492
US

IV. Provider business mailing address

7 BRIGHAMS COVE RD
WEST BATH ME
04530-6762
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-9873
  • Fax:
Mailing address:
  • Phone: 207-774-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCR1974
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: