Provider Demographics
NPI:1679878425
Name:BRYENTON, MATTHEW THANE (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THANE
Last Name:BRYENTON
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 1:12575 NEWPORT AVE
Mailing Address - Street 2:C
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2451
Mailing Address - Country:US
Mailing Address - Phone:714-544-1355
Mailing Address - Fax:714-544-1366
Practice Address - Street 1:12575 NEWPORT AVE
Practice Address - Street 2:C
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2451
Practice Address - Country:US
Practice Address - Phone:714-544-1355
Practice Address - Fax:714-544-1366
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor