Provider Demographics
NPI:1548340441
Name:BROWN, KEVIN BURRISS (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BURRISS
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 1:20705 SOUTH ST STE F
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8650
Mailing Address - Country:US
Mailing Address - Phone:661-473-3473
Mailing Address - Fax:
Practice Address - Street 1:20705 SOUTH ST STE F
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8650
Practice Address - Country:US
Practice Address - Phone:661-473-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23216111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548340441OtherNPI
CAU52502Medicare UPIN