Provider Demographics
NPI:1649392622
Name:VALLEY CHIROPRACTIC
Entity Type:Organization
Organization Name:VALLEY CHIROPRACTIC
Other - Org Name:VALLEY CHIROPRACTIC SPORTS AND SPINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-362-0112
Mailing Address - Street 1:6330 SPRING MOUNTAIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8843
Mailing Address - Country:US
Mailing Address - Phone:702-362-0112
Mailing Address - Fax:702-252-7860
Practice Address - Street 1:6330 SPRING MOUNTAIN RD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8843
Practice Address - Country:US
Practice Address - Phone:702-362-0112
Practice Address - Fax:702-252-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00332111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT67147Medicare UPIN
NVV36288Medicare ID - Type UnspecifiedMEDICARE