Healthcare Provider Details

I. General information

NPI: 1083644728
Provider Name (Legal Business Name): BRIAN P KILLIAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 W ST JOE HWY
LANSING MI
48917-4215
US

IV. Provider business mailing address

926 ELMWOOD RD
LANSING MI
48917-2070
US

V. Phone/Fax

Practice location:
  • Phone: 517-327-7463
  • Fax: 517-886-5238
Mailing address:
  • Phone: 517-327-7463
  • Fax: 517-886-5238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007987
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: