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General NPI Number Information
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NPI Number | 1184727976
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Entity Type | Individual
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Provider Name | BRYAN JOSEPH CAPEN I D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 25136 JEFFERSON CT
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City | SOUTH LYON
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State | MI
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Zip | 48178-1173
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Country | US
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Telephone | 313-333-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 25136 JEFFERSON CT
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City | SOUTH LYON
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State | MI
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Zip | 48178-1173
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Country | US
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Telephone | 313-333-5250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301008720
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038011440
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License Number State | IL
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