MEDICARE: BROWN SPINAL CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038010595	IL

General Provider Information

NPI Number	:	1316108228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWN SPINAL CARE, INC.

Provider Business Mailing Address
First Line	:	912 IL ROUTE 22
Second Line	:
City	:	FOX RIVER GROVE
State	:	IL
Zip	:	60021-1905
Country	:	US
Telephone Number	:	847-516-7830
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 IL ROUTE 22
Second Line	:
City	:	FOX RIVER GROVE
State	:	IL
Zip	:	60021-1905
Country	:	US
Telephone Number	:	847-516-7830
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. CLARENCE W. BROWN III
Credential	:	D.C.
Telephone Number	:	847-516-7830

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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