Provider Demographics
NPI:1386685832
Name:BROWN, MARTIN JOEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOEL
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 1:14300 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5510
Mailing Address - Country:US
Mailing Address - Phone:586-979-6460
Mailing Address - Fax:
Practice Address - Street 1:14300 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5510
Practice Address - Country:US
Practice Address - Phone:586-979-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005127111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4351621Medicaid
MI4351621Medicaid
MIOM16850Medicare ID - Type Unspecified