Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC0004338-L | PA |
NPI | 1336129790 |
---|---|
Provider Name | Dr. Stephen Fitzsimmons Brown |
First Address | Dunmore, PA 18509-2132 |
Second Address | Dunmore, PA 18509-2132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 04/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012212490002 | (05) | PA |
2171 | (02) | PA |