Provider Demographics
NPI:1518160365
Name:BRADY CHIROPRATIC GROUP PC
Entity Type:Organization
Organization Name:BRADY CHIROPRATIC GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:KD
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-242-8162
Mailing Address - Street 1:514 28 ONE FOURTH RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4961
Mailing Address - Country:US
Mailing Address - Phone:970-242-8162
Mailing Address - Fax:970-245-4308
Practice Address - Street 1:514 28 ONE FOURTH RD UNIT 1
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4961
Practice Address - Country:US
Practice Address - Phone:970-242-8162
Practice Address - Fax:970-245-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1518160365OtherGROUP NPI
CO1720074792OtherINDIVIDUAL NPI
CO1790779171OtherINDIVIDUAL NPI
CO1578559548OtherINDIVIDUAL NPI
CO1518160365OtherGROUP NPI
CO1790779171OtherINDIVIDUAL NPI
CO551278Medicare PIN
CO1720074792OtherINDIVIDUAL NPI