Provider Demographics
NPI:1053954180
Name:BRYANT, AARON ALEXANDER (DC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:ALEXANDER
Last Name:BRYANT
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 1:910 W LAKE ST UNIT 4H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 N HALSTED ST STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2160
Practice Address - Country:US
Practice Address - Phone:312-285-2116
Practice Address - Fax:312-285-2324
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor