Provider Demographics
NPI:1235249244
Name:BRADY, WILLIAM JAMES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:BRADY
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:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001
Mailing Address - Country:US
Mailing Address - Phone:810-794-5000
Mailing Address - Fax:810-794-2226
Practice Address - Street 1:406 POINTE TREMBLE
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001
Practice Address - Country:US
Practice Address - Phone:810-794-5000
Practice Address - Fax:810-794-2226
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWB005681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F45009OtherBLUE CROSS
MI0F45009OtherBLUE CROSS