MEDICARE: DR. ROBERT E. BRADEN D.C.

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	111NS0005X	Sports Physician Chiropractor	B00332	NV

General Provider Information

NPI Number	:	1760422372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E. BRADEN D.C.

Provider Business Mailing Address
First Line	:	6300 SPRING MOUNTAIN RD.
Second Line	:	SUITE #C
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-362-0112
Fax Number	:	702-252-7860

Provider Business Practice Location Address
First Line	:	6300 SPRING MOUNTAIN RD.
Second Line	:	SUITE #C
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-362-0112
Fax Number	:	702-252-7860

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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