Provider Demographics
NPI:1285659029
Name:BROWN, DOUGLAS S (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
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 1:107 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-1106
Mailing Address - Country:US
Mailing Address - Phone:231-873-4400
Mailing Address - Fax:231-873-5443
Practice Address - Street 1:107 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1106
Practice Address - Country:US
Practice Address - Phone:231-873-4400
Practice Address - Fax:231-873-5443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB005569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350046466OtherRAILROAD MEDICARE ID#
MI950F410160OtherBCBS PROVIDER ID#
MI950F410160OtherBLUE CARE NETWORK ID#
MI0F45000Medicare PIN