Provider Demographics
NPI:1801987938
Name:BROUSE, DWAYNE ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:ALLEN
Last Name:BROUSE
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 1:10032 WARWICKSHIRE LANE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270
Mailing Address - Country:US
Mailing Address - Phone:704-845-5958
Mailing Address - Fax:
Practice Address - Street 1:10032 WARWICKSHIRE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2566
Practice Address - Country:US
Practice Address - Phone:704-840-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3389111N00000X
MDS02177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4765Medicare UPIN