MEDICARE: BREAGAN M MADEJEK D C, PLLC

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	261Q00000X	Clinic/Center	B01531	NV

General Provider Information

NPI Number	:	1376080093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAGAN M MADEJEK D C, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 563
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89125-0563
Country	:	US
Telephone Number	:	989-971-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 CASINO CENTER DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	989-971-9700
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. BREAGAN MARIE MADEJEK
Credential	:	D.C.
Telephone Number	:	989-971-9700

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	01/20/2017

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