Provider Demographics
NPI:1336129790
Name:BROWN, STEPHEN FITZSIMMONS (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FITZSIMMONS
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 1:1767 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2132
Mailing Address - Country:US
Mailing Address - Phone:570-341-5544
Mailing Address - Fax:570-341-5545
Practice Address - Street 1:1767 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18509-2132
Practice Address - Country:US
Practice Address - Phone:570-341-5544
Practice Address - Fax:570-341-5545
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0004338-L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012212490002Medicaid
PA2171Medicare UPIN
PABR609304Medicare ID - Type Unspecified