Provider Demographics
NPI:1033507504
Name:BROWN, JESSICA RUTH (DC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RUTH
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 1:951 N JONES RD
Mailing Address - Street 2:
Mailing Address - City:PIERSON
Mailing Address - State:MI
Mailing Address - Zip Code:49339-9754
Mailing Address - Country:US
Mailing Address - Phone:616-990-1842
Mailing Address - Fax:503-296-5303
Practice Address - Street 1:220 N C ST
Practice Address - Street 2:
Practice Address - City:TRUFANT
Practice Address - State:MI
Practice Address - Zip Code:49347-9799
Practice Address - Country:US
Practice Address - Phone:616-984-5200
Practice Address - Fax:503-296-5303
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5617111NP0017X
390200000X
MI2301010667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program