Provider Demographics
NPI:1013936483
Name:BROWN, CHARLES DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
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 1:3077 LEEMAN FERRY RD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5614
Mailing Address - Country:US
Mailing Address - Phone:256-319-3402
Mailing Address - Fax:256-319-2087
Practice Address - Street 1:3077 LEEMAN FERRY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5614
Practice Address - Country:US
Practice Address - Phone:256-319-3402
Practice Address - Fax:256-319-2087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51040756OtherBC/BS PROVIDER ID
AL1400OtherSTATE LICENSE NUMBER
ALU24308Medicare UPIN