Provider Demographics
NPI:1689877227
Name:VETTER, BRIAN CLANCY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CLANCY
Last Name:VETTER
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 1:8137 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-2023
Mailing Address - Country:US
Mailing Address - Phone:440-427-1602
Mailing Address - Fax:440-427-1598
Practice Address - Street 1:8137 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-2023
Practice Address - Country:US
Practice Address - Phone:440-427-1602
Practice Address - Fax:440-427-1598
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011506-1111N00000X
OH4131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093969Medicaid