Provider Demographics
NPI:1043307622
Name:BRADY, MICHAEL S (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
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 1:352 EAST BUTLER AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BRITAIN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:215-345-1445
Mailing Address - Fax:
Practice Address - Street 1:352 EAST BUTLER AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BRITAIN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-345-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006170L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2420348000OtherGROUP IDENTIFICATION
PA723451Medicare UPIN
PA2420348000OtherGROUP IDENTIFICATION
PA0797056000Medicare UPIN
PA723451Medicare ID - Type UnspecifiedPROVIDER NUMBER