Healthcare Provider Details

I. General information

NPI: 1649383233
Provider Name (Legal Business Name): ROBERT BRADY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 CUSTER RD SUITE 320
PLANO TX
75075-4418
US

IV. Provider business mailing address

2929 CUSTER RD SUITE 320
PLANO TX
75075-4418
US

V. Phone/Fax

Practice location:
  • Phone: 972-867-8500
  • Fax: 972-597-8509
Mailing address:
  • Phone: 972-867-8500
  • Fax: 972-597-8509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number9694
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: