Provider Demographics
NPI:1457573719
Name:BROWN, ELANA AVA (DC)
Entity Type:Individual
Prefix:DR
First Name:ELANA
Middle Name:AVA
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 1:135 OCEAN PARKWAY
Mailing Address - Street 2:#11N
Mailing Address - City:BKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:718-854-7689
Mailing Address - Fax:718-853-1700
Practice Address - Street 1:99 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218
Practice Address - Country:US
Practice Address - Phone:718-853-1818
Practice Address - Fax:718-853-1700
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0053051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X48801Medicare UPIN