Provider Demographics
NPI:1881772077
Name:BROWN, MATTHEW ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
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 1:2010 RIVER RUN TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6041
Mailing Address - Country:US
Mailing Address - Phone:616-249-2858
Mailing Address - Fax:260-739-7384
Practice Address - Street 1:625 KENMOOR AVE SE
Practice Address - Street 2:SUITE #301
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2395
Practice Address - Country:US
Practice Address - Phone:616-249-2858
Practice Address - Fax:260-739-7384
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI144742393Medicaid
MI144742393Medicaid
MI144742393Medicaid