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General NPI Number Information
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NPI Number | 1427278902
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Entity Type | Organization
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Legal Business Name | BRADY FORTES CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 608 SUTTER ST SUITE 100
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City | FOLSOM
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State | CA
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Zip | 95630-2545
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Country | US
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Telephone | 916-985-9686
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Fax | 916-985-9687
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Provider Business Mailing Address
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Address Line | 608 SUTTER ST SUITE 100
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City | FOLSOM
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State | CA
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Zip | 95630-2545
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Country | US
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Telephone | 916-985-9686
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Fax | 916-985-9687
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA C BRADY
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Credential | D.C.
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Telephone | 916-985-9686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 27087
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License Number State | CA
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