Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 01-03884 | KS |
N | 111NI0013X | Independent Medical Examiner | 01-03884 | KS |
NPI | 1912195157 |
---|---|
Provider Name | Dr. Michael E Brady |
First Address | Topeka, KS 66608-1440 |
Second Address | Topeka, KS 66608-1440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2007 |
Last Update Date | 12/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023627 | BLUE CROSS BLUE SHIELD (01) | KS |
T44109 | (02) | KS |