Logan Brown, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.005094 Issued in IL

Practice address

2430 W Warner Ave
Chicago, IL 60618-2812

Phone

(502) 648-1164

NPI assigned

Mar 3, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1548728116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2430 W WARNER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606182812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 W WARNER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606182812",
            "telephone_number": "502-648-1164"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "508 Ponder Dr",
            "address_purpose": "LOCATION",
            "city": "Shelbyville",
            "state": "KY",
            "postal_code": "400658957",
            "country_code": "US",
            "telephone_number": "502-648-1164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "LOGAN",
        "name_prefix": "Mr.",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-03",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.005094",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "B09-958-702",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Brown, MD
• Leah A Brown, PA-C, MMS
• Liam T Brown, LCSW
• Lisa Brown
• Lloyd Garth Brown, M.D.
• Logan Brown, MS
• Lorin Merrill Brown, M.D.
• Maggie Brown, LCSW
• Malcolm Brown
• Manasa Brown, MD

• Athletic Trainer in Chicago, IL
• Providers in Chicago, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.