Provider Demographics
NPI:1033139084
Name:BROWN, MARK W (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
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 1:4111 CALL FIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2516
Mailing Address - Country:US
Mailing Address - Phone:940-696-2211
Mailing Address - Fax:
Practice Address - Street 1:4111 CALL FIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2516
Practice Address - Country:US
Practice Address - Phone:940-696-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO81M0018Medicaid