Healthcare Provider Details

I. General information

NPI: 1881174993
Provider Name (Legal Business Name): BRYCE DONALDSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10A WINGCO LN
READING PA
19605-9783
US

IV. Provider business mailing address

10A WINGCO LN
READING PA
19605-9783
US

V. Phone/Fax

Practice location:
  • Phone: 610-484-3477
  • Fax:
Mailing address:
  • Phone: 610-484-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011395
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005838
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: