Provider Demographics
NPI:1013974674
Name:BROWN, DANIEL WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
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 1:4555 WILSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2370
Mailing Address - Country:US
Mailing Address - Phone:616-534-7503
Mailing Address - Fax:616-534-7573
Practice Address - Street 1:4555 WILSON AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2370
Practice Address - Country:US
Practice Address - Phone:616-534-7503
Practice Address - Fax:616-534-7573
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33018Medicare UPIN
MI10150001Medicare PIN