Provider Demographics
NPI:1073552618
Name:BROWN, SCOTT A (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
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 1:1297 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:DEPTFORD
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 3499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2285756000OtherAMERIHEALTH
MH223482806OtherHORIZON
NJ1758004Medicaid
NJ548666OtherAETNA
NJ548666OtherAETNA
NJU24655Medicare UPIN