Provider Demographics
NPI:1851370399
Name:BROWN, BRADLEY J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
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 1:901 E CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-1951
Mailing Address - Country:US
Mailing Address - Phone:319-283-1621
Mailing Address - Fax:319-283-3195
Practice Address - Street 1:901 E CHARLES ST
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-1951
Practice Address - Country:US
Practice Address - Phone:319-283-1621
Practice Address - Fax:319-283-3195
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0164830Medicaid
IA16483OtherWELLMARK
IA22506OtherMIDLANDS CHOICE
IA0164830Medicaid