Provider Demographics
NPI:1770659195
Name:BROWN, KENNETH LEONUSE (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEONUSE
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 1:6224 FAYETTEVILLE RD
Mailing Address - Street 2:STE 106B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6288
Mailing Address - Country:US
Mailing Address - Phone:919-544-8881
Mailing Address - Fax:919-544-8889
Practice Address - Street 1:6224 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 106B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6288
Practice Address - Country:US
Practice Address - Phone:919-544-8881
Practice Address - Fax:919-544-8889
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085FROtherBCBS
NC621714OtherUNITED HEALTH CARE
NC621714OtherACN
NC621714OtherCIGNA
NC890839WMedicaid
NC085FROtherCNC
NC085FROtherCNC
NC621714OtherACN