Provider Demographics
NPI:1730262247
Name:WILLIAMS, BRYAN JASON (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JASON
Last Name:WILLIAMS
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 1:600 W COVENTARY CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2512
Mailing Address - Country:US
Mailing Address - Phone:612-916-0532
Mailing Address - Fax:
Practice Address - Street 1:5109 S. CLIFF AVE.
Practice Address - Street 2:SUITE 500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-334-0900
Practice Address - Fax:605-334-0910
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3219111N00000X
SD1073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor