Provider Demographics
NPI:1811640519
Name:BRADY SPORTS CHIROPRACTIC
Entity type:Organization
Organization Name:BRADY SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-580-8003
Mailing Address - Street 1:919 WESCHLER AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1059
Mailing Address - Country:US
Mailing Address - Phone:814-580-8003
Mailing Address - Fax:
Practice Address - Street 1:1009 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1843
Practice Address - Country:US
Practice Address - Phone:814-824-6442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty