Provider Demographics
NPI:1457355182
Name:BROWN, REBECCA (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FOREST FALLS DR
Mailing Address - Street 2:STE 4
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6937
Mailing Address - Country:US
Mailing Address - Phone:207-846-5111
Mailing Address - Fax:207-846-5988
Practice Address - Street 1:50 FOREST FALLS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6937
Practice Address - Country:US
Practice Address - Phone:207-846-5111
Practice Address - Fax:207-846-5988
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2017-03-17
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
MECR822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME037903OtherBLUECROSSBLUESHIELDANTHEM
ME2265916OtherAETNA
MM5922OtherMEDICARE PTAN
ME037903OtherBLUECROSSBLUESHIELDANTHEM