Provider Demographics
NPI:1790131233
Name:FIELDING, BRADY LORIN (DC)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:LORIN
Last Name:FIELDING
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 1:1282 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5544
Mailing Address - Country:US
Mailing Address - Phone:208-297-4847
Mailing Address - Fax:844-328-5814
Practice Address - Street 1:1282 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5544
Practice Address - Country:US
Practice Address - Phone:208-297-4847
Practice Address - Fax:844-328-5814
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor