Healthcare Provider Details

I. General information

NPI: 1114387362
Provider Name (Legal Business Name): WILLIAM RAEN BROWDER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 W BROADWAY ST
NORTH LITTLE ROCK AR
72114-5526
US

IV. Provider business mailing address

636 W BROADWAY ST
NORTH LITTLE ROCK AR
72114-5526
US

V. Phone/Fax

Practice location:
  • Phone: 501-374-1153
  • Fax: 501-374-6213
Mailing address:
  • Phone: 501-374-1153
  • Fax: 501-374-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16129
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: