Provider Demographics
NPI:1194797365
Name:BROWN, ROGER H (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:H
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 1:2900 WESTOWN PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1315
Mailing Address - Country:US
Mailing Address - Phone:515-225-9368
Mailing Address - Fax:515-225-9368
Practice Address - Street 1:2900 WESTOWN PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1315
Practice Address - Country:US
Practice Address - Phone:515-225-9368
Practice Address - Fax:515-225-9368
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0168294Medicaid
IAIA0101OtherJOHN DEERE PROVIDER ID
IA10125445214165OtherEDI SUBMITTER ID
IA16829OtherBCBS
IA16829OtherBCBS