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NPI Code Detail

MEDICARE: DR. CLIFFTON K BRADY DC

MEDICARE: DR. CLIFFTON K BRADY DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor2205TN
2111N00000XChiropractor4867441-1202UT

General Provider Information

NPI Number : 1588854897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLIFFTON K BRADY DC
Provider Business Mailing Address
First Line : 41 E 400 N
Second Line : 151
City : LOGAN
State : UT
Zip : 84321-4020
Country : US
Telephone Number : 435-881-2926
Fax Number : 435-514-3787
Provider Business Practice Location Address
First Line : 267 N SPRING CREEK PKWY
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9775
Country : US
Telephone Number : 435-881-2926
Fax Number : 435-514-3787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2007
Last Update Date : 06/08/2012

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