1700350709 NPI number — DR. ERYN MCCALL BROWN DC

Table of content: DR. ERYN MCCALL BROWN DC (NPI 1700350709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700350709 NPI number — DR. ERYN MCCALL BROWN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
ERYN
Provider Middle Name:
MCCALL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADDOCK
Provider Other First Name:
ERYN
Provider Other Middle Name:
MCCALL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700350709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WILLOW CREEK PKWY STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALESTINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75801-4387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-729-5051
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4880 LA-22
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70471-6798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-717-1188
Provider Business Practice Location Address Fax Number:
985-792-7129
Provider Enumeration Date:
01/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  14006 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1997 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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