Provider Demographics
NPI:1679578306
Name:BROWN, THOMAS W (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
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 1:829 EAST STATE
Mailing Address - Street 2:P.O. BOX 528
Mailing Address - City:MTN. GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-0528
Mailing Address - Country:US
Mailing Address - Phone:417-926-4141
Mailing Address - Fax:417-926-3757
Practice Address - Street 1:829 EAST STATE
Practice Address - Street 2:
Practice Address - City:MTN. GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-0528
Practice Address - Country:US
Practice Address - Phone:417-926-4141
Practice Address - Fax:417-926-3757
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003677111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1679578306OtherNPI
MO350077266OtherRAIL ROAD MEDICARE
MOT78462Medicare UPIN
MO350077266OtherRAIL ROAD MEDICARE