Provider Demographics
NPI:1114221561
Name:BROWN, ERIC DANIEL (MA60143149)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA60143149
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 S BOWDISH
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-922-6559
Mailing Address - Fax:
Practice Address - Street 1:3922 S BOWDISH RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-9600
Practice Address - Country:US
Practice Address - Phone:509-922-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60143149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist