Provider Demographics
NPI:1831142694
Name:BRADY, JAMES T (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
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 1:1104 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5004
Mailing Address - Country:US
Mailing Address - Phone:785-749-0130
Mailing Address - Fax:785-749-0132
Practice Address - Street 1:1104 E 23RD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5004
Practice Address - Country:US
Practice Address - Phone:785-749-0130
Practice Address - Fax:785-749-0132
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSBRA013693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9552061302Medicaid
KS062129Medicare ID - Type Unspecified
KS9552061302Medicaid