Provider Demographics
NPI:1124181250
Name:BROWN, RONALD C (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
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 1:4415 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-2356
Mailing Address - Country:US
Mailing Address - Phone:574-753-4871
Mailing Address - Fax:574-753-4871
Practice Address - Street 1:4415 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2356
Practice Address - Country:US
Practice Address - Phone:574-753-4871
Practice Address - Fax:574-753-4871
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN482111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100070530Medicaid
U21023Medicare UPIN
IN100070530Medicaid