Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301010667 | MI |
N | 111NP0017X | Pediatric Chiropractor | 5617 | OR |
NPI | 1033507504 |
---|---|
Provider Name | Ms. Jessica Ruth Brown |
First Address | Pierson, MI 49339-9754 |
Second Address | Trufant, MI 49347-9799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2015 |
Last Update Date | 29/01/2020 |