Organization
BRADLEY E BRYANT DC PC
Active
Other names
Back Mountain Chiropractic Center
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY E BRYANT JR. DC (PRESIDENT BMCC)
(570) 675-1190
Entity
Organization
Contact information
Practice address
217 MEMORIAL HWY, DALLAS, PA 18612-1232
(570) 675-1190
(570) 675-5885
Mailing address
217 MEMORIAL HWY, DALLAS, PA 18612-1232
(570) 675-1190
(570) 675-5885
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC-007608-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BA881741
BLUE SHIELD
PA
Enumeration date
09/29/2005
Last updated
08/22/2020
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