Provider Demographics
NPI:1699931774
Name:HADERLIE, BRETT JAMES (DC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:JAMES
Last Name:HADERLIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E MAIN ST
Mailing Address - Street 2:# E
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2228
Mailing Address - Country:US
Mailing Address - Phone:801-768-2939
Mailing Address - Fax:801-768-2955
Practice Address - Street 1:380 E MAIN ST
Practice Address - Street 2:# E
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2228
Practice Address - Country:US
Practice Address - Phone:801-768-2939
Practice Address - Fax:801-768-2955
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70596331202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor