Provider Demographics
NPI:1164852927
Name:BROWN, DIAMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:DIAMOND
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 E 70TH ST STE CD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5345
Mailing Address - Country:US
Mailing Address - Phone:318-470-7516
Mailing Address - Fax:
Practice Address - Street 1:1950 E 70TH ST STE CD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5345
Practice Address - Country:US
Practice Address - Phone:318-470-7516
Practice Address - Fax:318-209-3841
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor