Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 482 | IN |
N | 111NR0200X | Radiology | 482 | IN |
N | 213ER0200X | Radiology | 482 | IN |
NPI | 1124181250 |
---|---|
Provider Name | Dr. Ronald C. Brown |
First Address | Logansport, IN 46947-2356 |
Second Address | Logansport, IN 46947-2356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 06/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100070530 | (05) | IN |
U21023 | (02) |