Bradley Jay Devereaux, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

368851-1202 Issued in UT

Practice address

190 W 100 S
Suite a
Bountiful, UT 84010-6205

Phone

(801) 292-1111

NPI assigned

Jun 12, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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

• Idaho Spine Clinic LLC

  • Chiropractor
  • Malad City, ID
  • NPI 1679805535
  NPD (past)

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093919359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 W 100 S",
            "address_2": "SUITE A",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106205",
            "telephone_number": "801-292-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 W 100 S",
            "address_2": "SUITE A",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106205",
            "telephone_number": "801-292-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVEREAUX",
        "first_name": "BRADLEY",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "368851-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Designs of Bountiful
• Jordan Alec Derbidge
• Deseret Health Group, LLC
• Desert Arch, LLC
• Ryan Colby Despain, DPT
• Shaun Claud Devoy
• Dicks Family Pharmacy Inc
• Hu Ding, MD
• Deanna Dixon
• Roxanna Dobran, DMD

• Chiropractor in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.