Provider Demographics
NPI:1457687386
Name:BROWN CHIROPRACTIC WELLNESS CENTER & SPA, LLC
Entity Type:Organization
Organization Name:BROWN CHIROPRACTIC WELLNESS CENTER & SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-628-5864
Mailing Address - Street 1:1001 E BOOTH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-1222
Mailing Address - Country:US
Mailing Address - Phone:573-682-4388
Mailing Address - Fax:573-682-1544
Practice Address - Street 1:201 W SWITZLER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-1035
Practice Address - Country:US
Practice Address - Phone:573-682-5864
Practice Address - Fax:573-682-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty