Provider Demographics
NPI:1396806758
Name:BROWN, DOUGLAS WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WAYNE
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 1:6013 TOWER CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3201
Mailing Address - Country:US
Mailing Address - Phone:703-751-6714
Mailing Address - Fax:703-751-6716
Practice Address - Street 1:6013 TOWER CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3201
Practice Address - Country:US
Practice Address - Phone:703-751-6714
Practice Address - Fax:703-751-6716
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
00058007045OtherAETNA PPO
VA103920OtherKAISER
0620282OtherAETNA HMO
BR172693Medicare ID - Type UnspecifiedMEDICARE NUMBER