Provider Demographics
NPI:1639400591
Name:BROWN, BRIAN L (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
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:PO BOX 50993
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-0017
Mailing Address - Country:US
Mailing Address - Phone:843-605-1600
Mailing Address - Fax:
Practice Address - Street 1:1259 38TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1313
Practice Address - Country:US
Practice Address - Phone:843-605-1600
Practice Address - Fax:843-872-0484
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3721111N00000X
NY011804-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor