Provider Demographics
NPI:1902044399
Name:BROWN, CLEVELAND D (DC)
Entity Type:Individual
Prefix:DR
First Name:CLEVELAND
Middle Name:D
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 1:1261 WICK LN
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3341
Mailing Address - Country:US
Mailing Address - Phone:412-583-2691
Mailing Address - Fax:
Practice Address - Street 1:1261 WICK LN
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3341
Practice Address - Country:US
Practice Address - Phone:412-583-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002474L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0879748Medicaid
PA102857Medicare PIN