Healthcare Provider Details

I. General information

NPI: 1104496314
Provider Name (Legal Business Name): RYAN BROWN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W DIXIE AVE STE 2
ELIZABETHTOWN KY
42701-1575
US

IV. Provider business mailing address

324 SAINT AMBROSE CHURCH LN
CECILIA KY
42724-9613
US

V. Phone/Fax

Practice location:
  • Phone: 850-582-8803
  • Fax:
Mailing address:
  • Phone: 850-582-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number270690
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: