Healthcare Provider Details

I. General information

NPI: 1073738845
Provider Name (Legal Business Name): SEAN PATRICK BRADY D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 FRANKFORT AVE
LOUISVILLE KY
40207-2555
US

IV. Provider business mailing address

3622 FRANKFORT AVE
LOUISVILLE KY
40207-2555
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-3392
  • Fax: 502-897-9850
Mailing address:
  • Phone: 502-897-3392
  • Fax: 502-897-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4087
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: