Provider Demographics
NPI:1174585210
Name:BRYSON, WILLIAM G JR (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:BRYSON
Suffix:JR
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 1:3120 O ST
Mailing Address - Street 2:STE B
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1548
Mailing Address - Country:US
Mailing Address - Phone:402-476-6767
Mailing Address - Fax:402-476-6003
Practice Address - Street 1:3120 O ST
Practice Address - Street 2:STE B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1548
Practice Address - Country:US
Practice Address - Phone:402-476-6767
Practice Address - Fax:402-476-6003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09552OtherBLUE CROSS BLUE SHIELD
NE10025042300Medicaid
NE09552OtherBLUE CROSS BLUE SHIELD
NE276760Medicare ID - Type Unspecified