Healthcare Provider Details

I. General information

NPI: 1083209753
Provider Name (Legal Business Name): BRADY R HEAPS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21802 E INDIANA AVE STE 106
LIBERTY LAKE WA
99019-4006
US

IV. Provider business mailing address

21802 E INDIANA AVE STE 106
LIBERTY LAKE WA
99019-4006
US

V. Phone/Fax

Practice location:
  • Phone: 509-639-1052
  • Fax: 844-746-0095
Mailing address:
  • Phone: 509-639-1052
  • Fax: 844-746-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61221873
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12192559-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: