Provider Demographics
NPI:1689806499
Name:BROWN, JASON WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:WAYNE
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 1:318 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-3113
Mailing Address - Country:US
Mailing Address - Phone:231-744-3332
Mailing Address - Fax:231-744-5551
Practice Address - Street 1:318 CENTER ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3113
Practice Address - Country:US
Practice Address - Phone:231-744-3332
Practice Address - Fax:231-744-5551
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor