Provider Demographics
NPI:1992802300
Name:BROWN, VINCENT LAWRENCE (DC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:LAWRENCE
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 1:125 E MAIN ST
Mailing Address - Street 2:1ST FLOOR OFFICE
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1310
Mailing Address - Country:US
Mailing Address - Phone:610-966-5111
Mailing Address - Fax:610-966-5484
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:1ST FLOOR OFFICE
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1310
Practice Address - Country:US
Practice Address - Phone:610-966-5111
Practice Address - Fax:610-966-5484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065055Medicare ID - Type Unspecified
PAU93014Medicare UPIN