Provider Demographics
NPI:1164524658
Name:WIRICK, BRADY MATTHEW (D,C,)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:MATTHEW
Last Name:WIRICK
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ASHMENT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5802
Mailing Address - Country:US
Mailing Address - Phone:208-218-8622
Mailing Address - Fax:
Practice Address - Street 1:1515 ASHMENT AVE STE 2
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5802
Practice Address - Country:US
Practice Address - Phone:208-218-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1203111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology