Provider Demographics
NPI:1053353979
Name:ALDRICH, BRYAN S (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:S
Last Name:ALDRICH
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 1:118 SPRINGHALL DR STE A
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5360
Mailing Address - Country:US
Mailing Address - Phone:843-735-7115
Mailing Address - Fax:843-735-7114
Practice Address - Street 1:118 SPRINGHALL DR STE A
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5360
Practice Address - Country:US
Practice Address - Phone:843-735-7115
Practice Address - Fax:843-735-7114
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-008982111N00000X
SC3134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU70982Medicare UPIN