Provider Demographics
NPI:1922304229
Name:DR. H. O. BROWN, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. H. O. BROWN, PROFESSIONAL CORPORATION
Other - Org Name:MIND AND BODY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HOUSTON
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-978-8600
Mailing Address - Street 1:3535 E NEW YORK ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4465
Mailing Address - Country:US
Mailing Address - Phone:630-978-8600
Mailing Address - Fax:
Practice Address - Street 1:3535 E NEW YORK ST
Practice Address - Street 2:SUITE 216
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4465
Practice Address - Country:US
Practice Address - Phone:630-978-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3140Medicare PIN