Provider Demographics
NPI:1942320635
Name:BROWN, MICHAEL LAWENCE (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWENCE
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 1:1257 E CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-8000
Mailing Address - Country:US
Mailing Address - Phone:740-753-1902
Mailing Address - Fax:740-753-4233
Practice Address - Street 1:1257 E CANAL ST
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-8000
Practice Address - Country:US
Practice Address - Phone:740-753-1902
Practice Address - Fax:740-753-4233
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2400111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2014886Medicaid
OH2014886Medicaid
OHBR0827462Medicare PIN