Provider Demographics
NPI:1578620423
Name:BROWN, SALLY JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:JEAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-4759
Mailing Address - Country:US
Mailing Address - Phone:262-633-9908
Mailing Address - Fax:262-638-9999
Practice Address - Street 1:2609 RAPIDS DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-1741
Practice Address - Country:US
Practice Address - Phone:262-638-9999
Practice Address - Fax:262-638-0742
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2961-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38873500Medicaid
WIU41194Medicare UPIN