Provider Demographics
NPI:1649383233
Name:BRADY, ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
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 1:2929 CUSTER RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4418
Mailing Address - Country:US
Mailing Address - Phone:972-867-8500
Mailing Address - Fax:972-597-8509
Practice Address - Street 1:2929 CUSTER RD
Practice Address - Street 2:SUITE 320
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4418
Practice Address - Country:US
Practice Address - Phone:972-867-8500
Practice Address - Fax:972-597-8509
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9694111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610649Medicare PIN