Provider Demographics
NPI:1154425486
Name:BROWN, MARK A (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
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 1:5211 S FLETCHER AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5370
Mailing Address - Country:US
Mailing Address - Phone:904-239-0449
Mailing Address - Fax:
Practice Address - Street 1:5211 S FLETCHER AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5370
Practice Address - Country:US
Practice Address - Phone:904-239-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T85521Medicare UPIN
FL70882YMedicare PIN
70882Medicare ID - Type Unspecified