Healthcare Provider Details

I. General information

NPI: 1881694859
Provider Name (Legal Business Name): ROBERT D BROWN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 E WASHINGTON ST SUITE 202
BLOOMINGTON IL
61704-4478
US

IV. Provider business mailing address

2422 E WASHINGTON ST SUITE 202
BLOOMINGTON IL
61704-4478
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-9900
  • Fax: 309-663-9901
Mailing address:
  • Phone: 309-663-9900
  • Fax: 309-663-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009333
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: