Healthcare Provider Details

I. General information

NPI: 1851373146
Provider Name (Legal Business Name): RANDY D BROWN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S MEARS AVE
WHITEHALL MI
49461-1729
US

IV. Provider business mailing address

1020 S MEARS AVE
WHITEHALL MI
49461-1729
US

V. Phone/Fax

Practice location:
  • Phone: 231-893-1755
  • Fax: 231-893-3595
Mailing address:
  • Phone: 231-893-1755
  • Fax: 231-893-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301003057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: