Provider Demographics
NPI:1043370307
Name:SCOTT A BROWN, D.C. P.A
Entity Type:Organization
Organization Name:SCOTT A BROWN, D.C. P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-848-4442
Mailing Address - Street 1:1297 CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3001
Mailing Address - Country:US
Mailing Address - Phone:856-848-4442
Mailing Address - Fax:856-848-1836
Practice Address - Street 1:1297 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3001
Practice Address - Country:US
Practice Address - Phone:856-848-4442
Practice Address - Fax:856-848-1836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2285756000OtherAMERIHELATH ID#
NJ1758004Medicaid
NJ2285756000OtherAMERIHELATH ID#
NJ=========OtherTAX ID NUMBER
NJ1758004Medicaid