Healthcare Provider Details

I. General information

NPI: 1982336798
Provider Name (Legal Business Name): JACOB BROWER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 WARDS RD
LYNCHBURG VA
24502-2101
US

IV. Provider business mailing address

1075 E LAWN DR APT 307
FOREST VA
24551-2988
US

V. Phone/Fax

Practice location:
  • Phone: 434-582-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number0116036389
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: