MEDICARE: DR. BLAKE THOMAS BROWN D.C.

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	17032	CA

General Provider Information

NPI Number	:	1891701140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE THOMAS BROWN D.C.

Provider Business Mailing Address
First Line	:	1532 STATE ST PH A
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2554
Country	:	US
Telephone Number	:	805-899-3955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 STATE ST
Second Line	:	SUITE A
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2556
Country	:	US
Telephone Number	:	805-899-2177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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