Provider Demographics
NPI:1295766921
Name:STEVEN RALPH BROWN
Entity type:Organization
Organization Name:STEVEN RALPH BROWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER HEAD CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-668-3399
Mailing Address - Street 1:231 OIL WELL RD
Mailing Address - Street 2:A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8015
Mailing Address - Country:US
Mailing Address - Phone:731-668-3399
Mailing Address - Fax:731-664-5455
Practice Address - Street 1:231 OIL WELL RD
Practice Address - Street 2:A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-8015
Practice Address - Country:US
Practice Address - Phone:731-668-3399
Practice Address - Fax:731-664-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN257, 135, 2125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3679821Medicare ID - Type Unspecified