Individual
MR. LOGAN BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
2430 W WARNER AVE, CHICAGO, IL 60618-2812
(502) 648-1164
Mailing address
2430 W WARNER AVE, CHICAGO, IL 60618-2812
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.005094
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B09-958-702
DRIVERS LICENSE
KY
Enumeration date
03/03/2019
Last updated
07/26/2021
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