MEDICARE: DR. GARY DEAN BROWN DC

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	111N00000X	Chiropractor	2379	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350053112	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5650029	OTHER		AETNA

General Provider Information

NPI Number	:	1447244421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DEAN BROWN DC

Provider Business Mailing Address
First Line	:	5602 SE 15TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-2612
Country	:	US
Telephone Number	:	405-737-8996
Fax Number	:	405-733-0227

Provider Business Practice Location Address
First Line	:	5602 SE 15TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-2612
Country	:	US
Telephone Number	:	405-737-8996
Fax Number	:	405-733-0227

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/15/2010

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