Provider Demographics
NPI:1356425623
Name:BROWN, LOUIS LEONARD (DC)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:LEONARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WOODY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:422 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3326
Mailing Address - Country:US
Mailing Address - Phone:727-518-1967
Mailing Address - Fax:727-518-1986
Practice Address - Street 1:520 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3408
Practice Address - Country:US
Practice Address - Phone:727-518-1967
Practice Address - Fax:727-518-1986
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
660066OtherACN PROVIDER #
FL53969OtherBLUE CROSS BLUE SHIELD
FL381709100Medicaid