Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH00034372 | WA |
NPI | 1003975491 |
---|---|
Provider Name | Dr. Randy S Bryant |
First Address | Bellevue, WA 98007-4752 |
Second Address | Bellevue, WA 98005-2534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 17/06/2009 |