Healthcare Provider Details

I. General information

NPI: 1124271358
Provider Name (Legal Business Name): RICHARD L BROWN DC05/09/1940
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914-C VIRGINIA AVE
CLARKSVILLE VA
23927-0933
US

IV. Provider business mailing address

PO BOX 933
CLARKSVILLE VA
23927-0933
US

V. Phone/Fax

Practice location:
  • Phone: 434-374-2143
  • Fax: 434-374-8017
Mailing address:
  • Phone: 434-374-2143
  • Fax: 434-374-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number0104000378
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: