Provider Demographics
NPI:1104813278
Name:BROWN, DAVID ALAN (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
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 1:24553 ARIC WAY
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3351
Mailing Address - Country:US
Mailing Address - Phone:574-875-6017
Mailing Address - Fax:
Practice Address - Street 1:16648 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:WHITE PIGEON
Practice Address - State:MI
Practice Address - Zip Code:49099-7706
Practice Address - Country:US
Practice Address - Phone:269-625-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB008622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G51037OtherBLUE CROSS BLUE SHIELD
0P01290Medicare UPIN