Healthcare Provider Details

I. General information

NPI: 1710170808
Provider Name (Legal Business Name): ERIC DAVID BRYANT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8041 CORPORATE CENTER DRIVE SUITE 100
CHARLOTTE NC
28226-4553
US

IV. Provider business mailing address

8041 CORPORATE CENTER DR SUITE 100
CHARLOTTE NC
28226-4554
US

V. Phone/Fax

Practice location:
  • Phone: 704-341-5200
  • Fax: 704-341-5282
Mailing address:
  • Phone: 704-341-5200
  • Fax: 704-341-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3744
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: