Provider Demographics
NPI:1659799872
Name:MADEJEK, BREAGAN
Entity Type:Individual
Prefix:DR
First Name:BREAGAN
Middle Name:
Last Name:MADEJEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 E LAKE MEAD BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7329
Mailing Address - Country:US
Mailing Address - Phone:702-642-1300
Mailing Address - Fax:
Practice Address - Street 1:3455 E LAKE MEAD BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7329
Practice Address - Country:US
Practice Address - Phone:702-642-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor