Healthcare Provider Details

I. General information

NPI: 1154715407
Provider Name (Legal Business Name): DR. H O BROWN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 E NEW YORK ST SUITE 216
AURORA IL
60504-4465
US

IV. Provider business mailing address

3535 E NEW YORK ST SUITE 216
AURORA IL
60504-4465
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-8600
  • Fax:
Mailing address:
  • Phone: 630-978-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011049
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1457392037
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070016409
License Number StateIL

VIII. Authorized Official

Name: DR. HOUSTON ORLANDO BROWN
Title or Position: OWNER
Credential: D.C.
Phone: 630-978-8600