Provider Demographics
NPI:1497747893
Name:BROWN, VINCENT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:DAVID
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 1:819 DAVIDSON DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4351
Mailing Address - Country:US
Mailing Address - Phone:980-777-8136
Mailing Address - Fax:980-777-8136
Practice Address - Street 1:819 DAVIDSON DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4351
Practice Address - Country:US
Practice Address - Phone:980-777-8136
Practice Address - Fax:980-777-8041
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0844UOtherBLUE CROSS/BLUE SHIELD
NC2652267OtherAETNA HMO
NC7001301OtherAETNA PPO
NC890844UMedicaid
NC2652267OtherAETNA HMO
NC890844UMedicaid