=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770637332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWN CHIROPRACTIC WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 W SWITZLER ST SUITE 1
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65240-1035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-682-5864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 W SWITZLER ST SUITE 1
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65240-1035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-682-5864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CHIROPRACTOR
-----------------------------------------------------
Name | DR. LORI CAROL BROWN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 573-682-5864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 006168
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------