Provider Demographics
NPI:1063402055
Name:BROWN, WILLIAM P (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:BROWN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13003 ECKEL JUNCTION RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7633
Mailing Address - Country:US
Mailing Address - Phone:419-874-0405
Mailing Address - Fax:419-874-0427
Practice Address - Street 1:13003 ECKEL JUNCTION RD STE 105
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:419-874-0405
Practice Address - Fax:419-874-0427
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH725885OtherFAMILY HEALTH PLAN
OH000000193661OtherANTHEM
OH0125993Medicaid
OH247800180005OtherMEDICAL MUTUAL OF OHIO
OHP00080570OtherRRB - MEDICARE
OH157124227OtherPPOM
OH2580173OtherCIGNA
OH341940537-00OtherWORKERS COMPENSATION
OH5349505OtherAETNA
OHU53168Medicare UPIN