Individual
DR. BRYAN MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
18924 EVAN ST., SUITE 105, ELKHORN, NE 68022
(531) 466-8611
(531) 999-3842
Mailing address
18924 EVANS ST, SUITE 105, ELKHORN, NE 68022
(531) 466-8611
(531) 999-3842
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2018
NE
111N00000X
Chiropractor
7473
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0941700
BCBS PROVIDER ID
AZ
Enumeration date
09/20/2006
Last updated
10/14/2019
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