Provider Demographics
NPI:1538111349
Name:BROWN, MARK EVERETT (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EVERETT
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 1:1905 JN PEASE PLACE
Mailing Address - Street 2:STE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-593-0031
Mailing Address - Fax:704-593-0058
Practice Address - Street 1:1905 JN PEASE PLACE
Practice Address - Street 2:STE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-593-0031
Practice Address - Fax:704-593-0058
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2447087AMedicare ID - Type Unspecified
U19646Medicare UPIN