Provider Demographics
NPI:1316187438
Name:BROWN, DANIEL W (LICAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:BROWN
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 BUSINESS ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:CENTER RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05736-9701
Mailing Address - Country:US
Mailing Address - Phone:802-773-3780
Mailing Address - Fax:
Practice Address - Street 1:279 BUSINESS ROUTE 4
Practice Address - Street 2:
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9701
Practice Address - Country:US
Practice Address - Phone:802-773-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000029171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist