Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7856550-1202 | UT |
N | 111NN1001X | Nutrition | DC 31638 | CA |
NPI | 1356660872 |
---|---|
Provider Name | Dr. Evan Edgar Brady |
First Address | Salt Lake City, UT 84117 |
Second Address | Salt Lake City, UT 84117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 11/12/2015 |