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: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 W NOB HILL BLVD
YAKIMA WA
98902-5104
US

IV. Provider business mailing address

2508 W NOB HILL BLVD
YAKIMA WA
98902-5104
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-5555
  • Fax: 509-469-4938
Mailing address:
  • Phone: 509-248-5555
  • Fax: 509-469-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: