Provider Demographics
NPI:1235151556
Name:BROWN, CHAD A (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:A
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 1:4294 LAKELAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9509
Mailing Address - Country:US
Mailing Address - Phone:601-936-6650
Mailing Address - Fax:
Practice Address - Street 1:4294 LAKELAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9509
Practice Address - Country:US
Practice Address - Phone:601-936-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7673387OtherAETNA
MS00120840Medicaid
MS6390083OtherCIGNA
MS604519OtherACN