Provider Demographics
NPI:1245286798
Name:BROWN, NICHOLAS RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RICHARD
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 1:2216 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-5022
Mailing Address - Country:US
Mailing Address - Phone:541-967-8060
Mailing Address - Fax:541-967-5089
Practice Address - Street 1:2216 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5022
Practice Address - Country:US
Practice Address - Phone:541-967-8060
Practice Address - Fax:541-967-5089
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
R107412Medicare ID - Type Unspecified