Provider Demographics
NPI:1356660872
Name:BRADY, EVAN EDGAR (DC)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:EDGAR
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 1:999 E MURRAY HOLLADAY RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117
Mailing Address - Country:US
Mailing Address - Phone:801-268-8090
Mailing Address - Fax:801-268-8097
Practice Address - Street 1:999 E MURRAY HOLLADAY RD.
Practice Address - Street 2:SUITE 103
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-268-8090
Practice Address - Fax:801-268-8097
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31638111NN1001X
UT7856550-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition