Healthcare Provider Details

I. General information

NPI: 1770637332
Provider Name (Legal Business Name): BROWN CHIROPRACTIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W SWITZLER ST SUITE 1
CENTRALIA MO
65240-1035
US

IV. Provider business mailing address

201 W SWITZLER ST SUITE 1
CENTRALIA MO
65240-1035
US

V. Phone/Fax

Practice location:
  • Phone: 573-682-5864
  • Fax:
Mailing address:
  • Phone: 573-682-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006168
License Number StateMO

VIII. Authorized Official

Name: DR. LORI CAROL BROWN
Title or Position: OWNER, CHIROPRACTOR
Credential: D.C.
Phone: 573-682-5864