Provider Demographics
NPI:1396848495
Name:BROWN, RICKEY LEE (DC)
Entity type:Individual
Prefix:MR
First Name:RICKEY
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 1:120 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5402
Mailing Address - Country:US
Mailing Address - Phone:870-862-9770
Mailing Address - Fax:870-862-2127
Practice Address - Street 1:120 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5402
Practice Address - Country:US
Practice Address - Phone:870-862-9770
Practice Address - Fax:870-862-2127
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119330718Medicaid
AR119330718Medicaid
AR119330718Medicaid