Provider Demographics
NPI:1972991289
Name:BROWN, AMANDA (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 80TH ST S STE 4
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3030
Mailing Address - Country:US
Mailing Address - Phone:651-459-2225
Mailing Address - Fax:651-458-8037
Practice Address - Street 1:7501 80TH ST S STE 4
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3030
Practice Address - Country:US
Practice Address - Phone:651-459-2225
Practice Address - Fax:651-458-8037
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor