Basic Information
Provider Information
NPI: 1003003732
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KATZ
FirstName: BRET
MiddleName: GABRIEL
NamePrefix: DR.
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4530 S EASTERN AVE
Address2: SUITE 6
City: LAS VEGAS
State: NV
PostalCode: 891196181
CountryCode: US
TelephoneNumber: 7023696242
FaxNumber:  
Practice Location
Address1: 4530 S EASTERN AVE
Address2: SUITE 6
City: LAS VEGAS
State: NV
PostalCode: 891196181
CountryCode: US
TelephoneNumber: 7023696242
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/26/2007
LastUpdateDate: 09/26/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000XB-789NVY Chiropractic ProvidersChiropractor 

No ID Information.


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