=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275302101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRETT BROWN CHIROPRACTIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2023
-----------------------------------------------------
Last Update Date | 12/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4849 VAN NUYS BLVD STE 200
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-205-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23672 PARK SEVILLA
-----------------------------------------------------
City | CALABASAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91302-1776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-205-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. GARRETT BROWN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 818-205-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------