Provider Demographics
NPI:1801151386
Name:BROWN CHIROPRACTIC WELLNESS CENTER WR PC
Entity type:Organization
Organization Name:BROWN CHIROPRACTIC WELLNESS CENTER WR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-971-4274
Mailing Address - Street 1:259 CARL VINSON PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5991
Mailing Address - Country:US
Mailing Address - Phone:478-922-7272
Mailing Address - Fax:
Practice Address - Street 1:259 CARL VINSON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5991
Practice Address - Country:US
Practice Address - Phone:478-922-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDQVOtherMEDICARE ID/ PTAN #:
GA1740483536OtherNPI #...INDIVIDUAL/TYPE 1: