Provider Demographics
NPI:1447369434
Name:BRYANT, III, ROY STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:STEPHEN
Last Name:BRYANT, III
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SACO AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-1600
Mailing Address - Country:US
Mailing Address - Phone:207-934-4600
Mailing Address - Fax:207-934-4606
Practice Address - Street 1:155 SACO AVE STE A2
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-1600
Practice Address - Country:US
Practice Address - Phone:207-934-4600
Practice Address - Fax:207-934-4606
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME023110OtherBLUE CROSS BLUE SHIELD
ME0004967Medicare PIN