Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 355063-1202 | UT |
NPI | 1306934393 |
---|---|
Provider Name | Dr. Eric J Brady |
First Address | Provo, UT 84601-1541 |
Second Address | Provo, UT 84601-1541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U6911 | (02) | UT |