Provider Demographics
NPI:1811071574
Name:BROWN, EDWARD WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
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 1:126 NO MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:VT
Mailing Address - Zip Code:05743
Mailing Address - Country:US
Mailing Address - Phone:802-265-3310
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 30
Practice Address - Street 2:CASTLETON CORNERS PROFESSIONAL CENTER
Practice Address - City:BOMOSEEN
Practice Address - State:VT
Practice Address - Zip Code:05732
Practice Address - Country:US
Practice Address - Phone:802-468-3123
Practice Address - Fax:802-468-3123
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060000636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0008761Medicaid
245030OtherCIGNA
BROW00008761OtherBC
VT8761Medicare ID - Type Unspecified