MEDICARE: MARY LEE BRADY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC-002993-L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	187672	OTHER	PA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	187672	OTHER	PA	PERSONAL CHOICE
2	1059212	OTHER	PA	KEYSTONE FIRST
3	0061117000	OTHER	PA	KEYSTONE 65
4	187672	OTHER	PA	BLUE CROSS & BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0061117000	OTHER	PA	KEYSTONE EAST

General Provider Information

NPI Number	:	1518965227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LEE BRADY D.C.

Provider Business Mailing Address
First Line	:	8712 FRANKFORD AVE
Second Line	:	1A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-1300
Country	:	US
Telephone Number	:	215-332-7828
Fax Number	:	215-332-7824

Provider Business Practice Location Address
First Line	:	8712 FRANKFORD AVE
Second Line	:	1A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-1300
Country	:	US
Telephone Number	:	215-332-7828
Fax Number	:	215-332-7824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/05/2016

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Directions to “ MARY LEE BRADY D.C.” Practice Location

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