Provider Demographics
NPI:1083209753
Name:HEAPS, BRADY R (DC)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:R
Last Name:HEAPS
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 1:2508 W NOB HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5104
Mailing Address - Country:US
Mailing Address - Phone:509-248-5555
Mailing Address - Fax:509-469-4938
Practice Address - Street 1:2508 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5104
Practice Address - Country:US
Practice Address - Phone:509-248-5555
Practice Address - Fax:509-469-4938
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12192559-1202111N00000X
WACH61221873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor