Provider Demographics
NPI:1730324419
Name:LOGAN, BRIAN KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:LOGAN
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 1:2000 W HENDERSON RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2453
Mailing Address - Country:US
Mailing Address - Phone:614-326-2225
Mailing Address - Fax:
Practice Address - Street 1:2000 W HENDERSON RD
Practice Address - Street 2:SUITE 255
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2453
Practice Address - Country:US
Practice Address - Phone:614-326-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor