Individual provider Active NPI

Brady R Heaps, DC

  • Chiropractor
  • Liberty Lake, WA
National Provider Identifier
1083209753
Registry record updated Jul 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
12192559-1202 Issued in UT
Practice address
21802 E Indiana Ave Ste 106
Liberty Lake, WA 99019-4006
Phone
(509) 639-1052
Fax
(844) 746-0095
NPI assigned
Mar 4, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH61221873 WA
Chiropractor 111N00000X 12192559-1202 UT Primary

Addresses

Primary practice location

21802 E Indiana Ave Ste 106
Liberty Lake, WA 99019-4006

Mailing address

21802 E Indiana Ave Ste 106
Liberty Lake, WA 99019-4006
Phone (509) 639-1052

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211217002033 WA Practitioner - Chiropractic 4981095361

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12192559-1202UTMDChiropractor
CH61221873WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Brady Heaps Chiropractic Chiropractor Current Accepting new patients
Wasatch Back Wellness, PLLC PastSince Mar 1, 2021 Accepting new patients

Locations

21802 E Indiana Ave
Ste 106
Liberty Lake, WA 99019
Phone (509) 639-1052

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785369600000",
    "number": "1083209753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21802 E INDIANA AVE STE 106",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990194006",
            "telephone_number": "509-639-1052",
            "fax_number": "844-746-0095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21802 E INDIANA AVE STE 106",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990194006",
            "telephone_number": "509-639-1052",
            "fax_number": "844-746-0095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEAPS",
        "first_name": "BRADY",
        "middle_name": "R",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-04",
        "last_updated": "2026-07-30",
        "certification_date": "2026-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH61221873",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "12192559-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.