Healthcare Provider Details

I. General information

NPI: 1275687295
Provider Name (Legal Business Name): ANDREW WILLIAM BROWN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12203 ABERDEEN ST NE # 140
BLAINE MN
55449-4719
US

IV. Provider business mailing address

2508 COUNTY ROAD I APT 102
MOUNDS VIEW MN
55112-6228
US

V. Phone/Fax

Practice location:
  • Phone: 763-785-4120
  • Fax: 763-785-4172
Mailing address:
  • Phone: 218-591-4801
  • Fax: 763-785-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4867
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: