Provider Demographics
NPI:1760422372
Name:BRADEN, ROBERT E (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:BRADEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 SPRING MOUNTAIN RD.
Mailing Address - Street 2:SUITE #C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-362-0112
Mailing Address - Fax:702-252-7860
Practice Address - Street 1:6300 SPRING MOUNTAIN RD.
Practice Address - Street 2:SUITE #C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-362-0112
Practice Address - Fax:702-252-7860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00332111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT67147Medicare UPIN
NVV36288Medicare ID - Type Unspecified