Provider Demographics
NPI:1659431468
Name:BROWN, TIMOTHY (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
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 1124
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95378-1124
Mailing Address - Country:US
Mailing Address - Phone:209-835-6625
Mailing Address - Fax:209-835-6871
Practice Address - Street 1:1458 BESSIE AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3417
Practice Address - Country:US
Practice Address - Phone:209-835-6625
Practice Address - Fax:209-835-6871
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU68706Medicare UPIN
CADC0242950Medicare ID - Type Unspecified