Provider Demographics
NPI:1720299472
Name:BRADY, DANIEL P (PA-C, DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:BRADY
Suffix:
Gender:M
Credentials:PA-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W PLUMB LN # 185
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3468
Mailing Address - Country:US
Mailing Address - Phone:775-636-6200
Mailing Address - Fax:775-249-0010
Practice Address - Street 1:1 E LIBERTY ST STE 600
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2110
Practice Address - Country:US
Practice Address - Phone:775-636-6200
Practice Address - Fax:775-249-0010
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-31007175L00000X
NVPA1576363A00000X
NVB01391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No175L00000XOther Service ProvidersHomeopath
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV109758Medicare UPIN