MEDICARE: THOMAS W. 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	111NI0900X	Internist Chiropractor	003677	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350077266	OTHER	MO	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1679578306	OTHER	MO	NPI

General Provider Information

NPI Number	:	1679578306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS W. BROWN DC

Provider Business Mailing Address
First Line	:	829 EAST STATE
Second Line	:	P.O. BOX 528
City	:	MTN. GROVE
State	:	MO
Zip	:	65711-0528
Country	:	US
Telephone Number	:	417-926-4141
Fax Number	:	417-926-3757

Provider Business Practice Location Address
First Line	:	829 EAST STATE
Second Line	:
City	:	MTN. GROVE
State	:	MO
Zip	:	65711-0528
Country	:	US
Telephone Number	:	417-926-4141
Fax Number	:	417-926-3757

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/06/2008

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