Provider Demographics
NPI:1780671339
Name:BROWN, KATHRYN R (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:R
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 1:4403 1ST AVE SE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3200
Mailing Address - Country:US
Mailing Address - Phone:319-393-0911
Mailing Address - Fax:319-393-0955
Practice Address - Street 1:4403 1ST AVE SE
Practice Address - Street 2:STE 304
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3221
Practice Address - Country:US
Practice Address - Phone:319-393-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0214262Medicaid
IA0214262Medicaid
IA20707Medicare ID - Type Unspecified