Provider Demographics
NPI:1417975004
Name:BROWN, WAYNE R (DC, DAAPM)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:DC, DAAPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5009
Mailing Address - Country:US
Mailing Address - Phone:973-783-1800
Mailing Address - Fax:973-783-1980
Practice Address - Street 1:70 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-5907
Practice Address - Country:US
Practice Address - Phone:973-783-1800
Practice Address - Fax:973-783-1980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00402300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ671257Medicare ID - Type Unspecified