Provider Demographics
NPI:1376080093
Name:BREAGAN M MADEJEK D C, PLLC
Entity Type:Organization
Organization Name:BREAGAN M MADEJEK D C, PLLC
Other - Org Name:SOUTHERN NEVADA MUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BREAGAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MADEJEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-971-9700
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89125-0563
Mailing Address - Country:US
Mailing Address - Phone:989-971-9700
Mailing Address - Fax:
Practice Address - Street 1:1212 CASINO CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104
Practice Address - Country:US
Practice Address - Phone:989-971-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01531261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center