MEDICARE: DR. BREAGAN MADEJEK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B01531	NV

General Provider Information

NPI Number	:	1659799872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BREAGAN MADEJEK

Provider Business Mailing Address
First Line	:	3455 E LAKE MEAD BLVD
Second Line	:	SUITE #1
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7329
Country	:	US
Telephone Number	:	702-642-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 E LAKE MEAD BLVD
Second Line	:	SUITE #1
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7329
Country	:	US
Telephone Number	:	702-642-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	04/04/2014

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Directions to “ DR. BREAGAN MADEJEK ” Practice Location

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