Provider Demographics
NPI:1902558356
Name:ATTALES, BRENNAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:
Last Name:ATTALES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 N COMMERCE ST UNIT 1001
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-1182
Mailing Address - Country:US
Mailing Address - Phone:337-499-6398
Mailing Address - Fax:
Practice Address - Street 1:2590 NATURE PARK DR STE 135
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3187
Practice Address - Country:US
Practice Address - Phone:702-636-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor