Provider Demographics
NPI:1568897445
Name:BROWN FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BROWN FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NICCOLAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-598-0918
Mailing Address - Street 1:6232 BANKERS RD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9747
Mailing Address - Country:US
Mailing Address - Phone:262-598-0918
Mailing Address - Fax:262-598-0941
Practice Address - Street 1:6240 BANKERS RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9747
Practice Address - Country:US
Practice Address - Phone:262-598-0918
Practice Address - Fax:262-598-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2961-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38873500Medicaid
WI38873500Medicaid
WIU41194Medicare UPIN