Provider Demographics
NPI:1134286644
Name:BROWN, GEORGE R (DC CCN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:DC CCN
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC CCN
Mailing Address - Street 1:500 DAVIS ST
Mailing Address - Street 2:SUITE 815
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4668
Mailing Address - Country:US
Mailing Address - Phone:847-425-9120
Mailing Address - Fax:847-425-9125
Practice Address - Street 1:500 DAVIS ST
Practice Address - Street 2:SUITE 815
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4668
Practice Address - Country:US
Practice Address - Phone:847-425-9120
Practice Address - Fax:847-425-9125
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215443Medicare UPIN
723690Medicare UPIN