Provider Demographics
NPI:1083644728
Name:KILLIAN, BRIAN P (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:KILLIAN
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 1:926 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2070
Mailing Address - Country:US
Mailing Address - Phone:517-327-7463
Mailing Address - Fax:517-886-5238
Practice Address - Street 1:4004 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4215
Practice Address - Country:US
Practice Address - Phone:517-327-7463
Practice Address - Fax:517-886-5238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor