Provider Demographics
NPI:1164506804
Name:BROWN, SCOTT D (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
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 1:207 BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102
Mailing Address - Country:US
Mailing Address - Phone:803-433-2992
Mailing Address - Fax:803-433-0084
Practice Address - Street 1:207 BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-433-2992
Practice Address - Fax:803-433-0084
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH118Medicaid
SCCH1707Medicaid
PAHI01OtherPENNSYLVANIA HIGHMARK BS
U41324Medicare UPIN