Provider Demographics
NPI:1942368345
Name:BROWN, DEVRON L (DC)
Entity Type:Individual
Prefix:DR
First Name:DEVRON
Middle Name:L
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 1:352 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1657
Mailing Address - Country:US
Mailing Address - Phone:435-882-7200
Mailing Address - Fax:435-882-1211
Practice Address - Street 1:352 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-1657
Practice Address - Country:US
Practice Address - Phone:435-882-7200
Practice Address - Fax:435-882-1211
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT355078-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU69829Medicare UPIN
UT000057042Medicare PIN