Provider Demographics
NPI:1295231967
Name:BROWN, EVAN (DAC, LAC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAC, LAC
Mailing Address - Street 1:125 ALLIE RUN
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-7400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 HARRODSBURG RD STE 105
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1257
Practice Address - Country:US
Practice Address - Phone:859-545-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist