Provider Demographics
NPI:1437600137
Name:BRADY, WILLIAM JAY (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAY
Last Name:BRADY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:JAY
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:12030 LITTLE PATUXENT PKWY APT Q
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4817
Mailing Address - Country:US
Mailing Address - Phone:410-997-3051
Mailing Address - Fax:
Practice Address - Street 1:3301 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1257
Practice Address - Country:US
Practice Address - Phone:410-732-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03688111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition