Provider Demographics
NPI:1013119478
Name:BROWN, MARTIN A (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:A
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 1:29 E MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-2551
Mailing Address - Country:US
Mailing Address - Phone:609-641-6880
Mailing Address - Fax:609-383-1361
Practice Address - Street 1:29 E MILL RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-2551
Practice Address - Country:US
Practice Address - Phone:609-641-6880
Practice Address - Fax:609-383-1361
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ001263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ166077Medicare ID - Type UnspecifiedPROVIDER NUMBER