Provider Demographics
NPI:1770171258
Name:BROWN, JUSTIN GREGORY (DC, MS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:GREGORY
Last Name:BROWN
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8707 OLD BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4435
Mailing Address - Country:US
Mailing Address - Phone:502-231-4003
Mailing Address - Fax:
Practice Address - Street 1:8707 OLD BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4435
Practice Address - Country:US
Practice Address - Phone:502-231-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor