Provider Demographics
NPI:1801985098
Name:BROWN, GLEN DALE JR (DC)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:DALE
Last Name:BROWN
Suffix:JR
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 1:3007 S HAZEL ST
Mailing Address - Street 2:STE 2
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5700
Mailing Address - Country:US
Mailing Address - Phone:870-534-8212
Mailing Address - Fax:870-534-8216
Practice Address - Street 1:3007 S HAZEL ST
Practice Address - Street 2:STE 2
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5700
Practice Address - Country:US
Practice Address - Phone:870-534-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor