Provider Demographics
NPI:1023430899
Name:SPILLE, BRENT (DC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SPILLE
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 1:5248 COURSEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2302
Mailing Address - Country:US
Mailing Address - Phone:513-398-6300
Mailing Address - Fax:513-398-6363
Practice Address - Street 1:5248 COURSEVIEW DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2302
Practice Address - Country:US
Practice Address - Phone:513-398-6300
Practice Address - Fax:513-398-6363
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor