Provider Demographics
NPI:1235124751
Name:BROWN, DONALD G (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
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 1:228 PAPERJACK DR
Mailing Address - Street 2:3B
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2430
Mailing Address - Country:US
Mailing Address - Phone:715-246-2110
Mailing Address - Fax:
Practice Address - Street 1:228 PAPERJACK DR
Practice Address - Street 2:3B
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2430
Practice Address - Country:US
Practice Address - Phone:715-246-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3544-012111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38924200Medicaid
WI35182Medicare ID - Type Unspecified
WI38924200Medicaid