Provider Demographics
NPI:1629037783
Name:BROWN, GREGORY C (LAC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:201 HARDING BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2814
Mailing Address - Country:US
Mailing Address - Phone:916-784-2727
Mailing Address - Fax:916-784-3821
Practice Address - Street 1:201 HARDING BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2814
Practice Address - Country:US
Practice Address - Phone:916-784-2727
Practice Address - Fax:916-784-3821
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC3747171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist