Healthcare Provider Details

I. General information

NPI: 1104021435
Provider Name (Legal Business Name): BRYAN CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 GRAND AVE SUITE 114
SAINT PAUL MN
55105-3022
US

IV. Provider business mailing address

1053 GRAND AVE SUITE 114
SAINT PAUL MN
55105-3022
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-9247
  • Fax: 651-292-9257
Mailing address:
  • Phone: 651-292-9247
  • Fax: 651-292-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4416
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4416
License Number StateMN

VIII. Authorized Official

Name: DR. CHRISTOPHER TAD BRYAN
Title or Position: OWNER - PRESIDENT
Credential: D.C.
Phone: 651-292-9247