Healthcare Provider Details

I. General information

NPI: 1740296938
Provider Name (Legal Business Name): BRADY WILLIAM PATENAUDE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 HUDSON AVE. SUITE 2
STILLWATER NY
12170-0427
US

IV. Provider business mailing address

PO BOX 427
STILLWATER NY
12170-0427
US

V. Phone/Fax

Practice location:
  • Phone: 518-664-4525
  • Fax: 518-664-1256
Mailing address:
  • Phone: 518-664-4525
  • Fax: 518-664-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number011152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: