Provider Demographics
NPI:1487952198
Name:BROWN, CHRISTOPHER DOMINIQUE
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DOMINIQUE
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 W CHARLESTON BLVD APT 22
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1045
Mailing Address - Country:US
Mailing Address - Phone:832-816-6286
Mailing Address - Fax:
Practice Address - Street 1:6501 W CHARLESTON BLVD APT 22
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1045
Practice Address - Country:US
Practice Address - Phone:832-816-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner