Provider Demographics
NPI:1780727115
Name:BROWN, JAMES WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
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 1:432 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-5002
Mailing Address - Country:US
Mailing Address - Phone:419-522-4672
Mailing Address - Fax:419-522-2652
Practice Address - Street 1:432 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-5002
Practice Address - Country:US
Practice Address - Phone:419-522-4672
Practice Address - Fax:419-522-2652
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-1575345-00OtherWORKERS COMP
OH2040268Medicaid
OH31-1575345OtherTAX ID
OH31-1575345-00OtherWORKERS COMP