Healthcare Provider Details

I. General information

NPI: 1104354612
Provider Name (Legal Business Name): BENJAMIN ROBERT BROWN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 OLIVE BLVD
OLIVETTE MO
63132-3130
US

IV. Provider business mailing address

4460 N ILLINOIS ST STE 5
SWANSEA IL
62226-1899
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-2444
  • Fax:
Mailing address:
  • Phone: 618-744-7314
  • Fax: 618-257-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2017015799
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013195
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: