Provider Demographics
NPI:1356574545
Name:BROWN, DANIEL LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
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 1:6040 CAMP BOWIE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5612
Mailing Address - Country:US
Mailing Address - Phone:817-763-8301
Mailing Address - Fax:817-764-6488
Practice Address - Street 1:6040 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5612
Practice Address - Country:US
Practice Address - Phone:817-763-8301
Practice Address - Fax:817-764-6488
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX275552015OtherITIN