Provider Demographics
NPI:1588854897
Name:BRADY, CLIFFTON K (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFFTON
Middle Name:K
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 1:41 E 400 N
Mailing Address - Street 2:151
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4020
Mailing Address - Country:US
Mailing Address - Phone:435-881-2926
Mailing Address - Fax:435-514-3787
Practice Address - Street 1:267 N SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9775
Practice Address - Country:US
Practice Address - Phone:435-881-2926
Practice Address - Fax:435-514-3787
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2205111N00000X
UT4867441-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor