Provider Demographics
NPI:1639170269
Name:BROWN, JEFFREY DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DUANE
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 1:401 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4247
Mailing Address - Country:US
Mailing Address - Phone:701-845-8060
Mailing Address - Fax:701-845-8067
Practice Address - Street 1:132 4TH AVE NORTHEAST
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3209
Practice Address - Country:US
Practice Address - Phone:701-845-8060
Practice Address - Fax:701-845-8067
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN713420OtherBLUE CROSS BLUE SHIELD
ND17477Medicaid
NDN714183Medicare PIN
NDU39364Medicare UPIN
NDN713420Medicare PIN