Provider Demographics
NPI:1346358785
Name:BROWN, JACOB LEWIS (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:LEWIS
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 1:119 N SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1928
Mailing Address - Country:US
Mailing Address - Phone:586-746-7846
Mailing Address - Fax:
Practice Address - Street 1:119 N SHELBY ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1928
Practice Address - Country:US
Practice Address - Phone:586-746-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009218111N00000X
IL038011071111N00000X
MIJB009218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038011071OtherLICENSE
IL1477690865OtherGROUP NPI
IL7521142OtherBLUE CROSS/BLUE SHIELD IL
IL11640363OtherCAHQ
IL210868OtherMEDICARE GROUP PTAN
MI2301009218OtherLICENSE
IL885287OtherHEALTHLINK
IL11640363OtherCAHQ
IL210868OtherMEDICARE GROUP PTAN