Healthcare Provider Details

I. General information

NPI: 1285659029
Provider Name (Legal Business Name): DOUGLAS S. BROWN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E MAIN ST
HART MI
49420-1106
US

IV. Provider business mailing address

107 E MAIN ST
HART MI
49420-1106
US

V. Phone/Fax

Practice location:
  • Phone: 231-873-4400
  • Fax: 231-873-5443
Mailing address:
  • Phone: 231-873-4400
  • Fax: 231-873-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDB005569
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: