Provider Demographics
NPI:1891099198
Name:BROWN, NICHOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
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 1:236 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-1923
Mailing Address - Country:US
Mailing Address - Phone:812-229-0655
Mailing Address - Fax:
Practice Address - Street 1:3128 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2665
Practice Address - Country:US
Practice Address - Phone:812-232-3718
Practice Address - Fax:812-232-7247
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002544A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN150270001OtherMEDICARE PTAN
IN201030750Medicaid