Provider Demographics
NPI:1700855988
Name:BROWN, NICHOLE PARRIS (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:PARRIS
Last Name:BROWN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 GREENVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1515
Mailing Address - Country:US
Mailing Address - Phone:864-949-9696
Mailing Address - Fax:864-949-9059
Practice Address - Street 1:12301 GREENVILLE HWY
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1515
Practice Address - Country:US
Practice Address - Phone:864-949-9696
Practice Address - Fax:864-949-9059
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2717Medicaid
SC7384Medicare ID - Type Unspecified
SCU903827384Medicare UPIN