Provider Demographics
NPI:1740423045
Name:BREWER, HERBERT LEON III (DC)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:LEON
Last Name:BREWER
Suffix:III
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 1:9067 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1230
Mailing Address - Country:US
Mailing Address - Phone:901-270-7420
Mailing Address - Fax:
Practice Address - Street 1:9067 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1230
Practice Address - Country:US
Practice Address - Phone:901-270-7420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV88-0441715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS18446OtherBCBS OF MS
MS0141OtherPT
MS709OtherSTATE OF MS
MS350000022Medicare PIN