Provider Demographics
NPI:1003993403
Name:BRADY, WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BRADY
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 1:15 COURT SQ
Mailing Address - Street 2:SUITE 840
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2503
Mailing Address - Country:US
Mailing Address - Phone:617-367-3110
Mailing Address - Fax:617-367-3101
Practice Address - Street 1:15 COURT SQ
Practice Address - Street 2:SUITE 840
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2503
Practice Address - Country:US
Practice Address - Phone:617-367-3110
Practice Address - Fax:617-367-3101
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU75357Medicare UPIN