Provider Demographics
NPI:1720074792
Name:BRADY, TIMOTHY K (DC)
Entity Type:Individual
Prefix:PROF
First Name:TIMOTHY
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 1:514 28 1/4 RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4961
Mailing Address - Country:US
Mailing Address - Phone:970-242-8162
Mailing Address - Fax:970-245-4308
Practice Address - Street 1:514 28 1/4 RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4961
Practice Address - Country:US
Practice Address - Phone:970-242-8162
Practice Address - Fax:970-245-4308
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1292111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1518160365OtherGROUP NPI
CO1518160365OtherGROUP NPI
COC487448Medicare PIN