Healthcare Provider Details

I. General information

NPI: 1356574545
Provider Name (Legal Business Name): DANIEL LEE BROWN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 CAMP BOWIE BLVD SUITE 2
FORT WORTH TX
76116-5612
US

IV. Provider business mailing address

6040 CAMP BOWIE BLVD SUITE 2
FORT WORTH TX
76116-5612
US

V. Phone/Fax

Practice location:
  • Phone: 817-763-8301
  • Fax: 817-764-6488
Mailing address:
  • Phone: 817-763-8301
  • Fax: 817-764-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: