Healthcare Provider Details

I. General information

NPI: 1104086180
Provider Name (Legal Business Name): BRYSON CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 RAHWAY AVE
WOODBRIDGE NJ
07095-3305
US

IV. Provider business mailing address

446 RAHWAY AVE
WOODBRIDGE NJ
07095-3305
US

V. Phone/Fax

Practice location:
  • Phone: 732-596-0333
  • Fax: 732-596-0335
Mailing address:
  • Phone: 732-596-0333
  • Fax: 732-596-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00510200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00998900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00713400
License Number StateNJ

VIII. Authorized Official

Name: JOSEPH A BRYSON
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C
Phone: 732-596-0333