Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2322 | MA |
NPI | 1003993403 |
---|---|
Provider Name | Dr. William Brady |
First Address | Boston, MA 02108-2503 |
Second Address | Boston, MA 02108-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U75357 | (02) | MA |