Healthcare Provider Details

I. General information

NPI: 1649392622
Provider Name (Legal Business Name): VALLEY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 SPRING MOUNTAIN RD STE C
LAS VEGAS NV
89146-8843
US

IV. Provider business mailing address

6330 SPRING MOUNTAIN RD STE C
LAS VEGAS NV
89146-8843
US

V. Phone/Fax

Practice location:
  • Phone: 702-362-0112
  • Fax: 702-252-7860
Mailing address:
  • Phone: 702-362-0112
  • Fax: 702-252-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberB00332
License Number StateNV

VIII. Authorized Official

Name: DR. ROBERT E. BRADEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 702-362-0112