Provider Demographics
NPI:1417031816
Name:BROWN, M E (DC)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:E
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC, APC, APCP
Mailing Address - Street 1:755 S TELSHOR BLVD
Mailing Address - Street 2:SUITE 102-B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4688
Mailing Address - Country:US
Mailing Address - Phone:575-522-8085
Mailing Address - Fax:575-522-8086
Practice Address - Street 1:755 S TELSHOR BLVD
Practice Address - Street 2:SUITE 102-B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4688
Practice Address - Country:US
Practice Address - Phone:575-522-8085
Practice Address - Fax:575-522-8086
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00K924OtherBCBS PROVIDER NUMBER
NM00KB46OtherBCBS PROVIDER NUMBER
NM2672836Medicare ID - Type Unspecified
NMT40867Medicare UPIN