MEDICARE: DR BRIAN C VETTER CHIROPRACTOR PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4131	OH

General Provider Information

NPI Number	:	1265722185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BRIAN C VETTER CHIROPRACTOR PC

Provider Business Mailing Address
First Line	:	8137 COLUMBIA RD
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-2023
Country	:	US
Telephone Number	:	440-427-1602
Fax Number	:	440-427-1598

Provider Business Practice Location Address
First Line	:	8137 COLUMBIA RD
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-2023
Country	:	US
Telephone Number	:	440-427-1602
Fax Number	:	440-427-1598

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN CLANCY VETTER
Credential	:	D.C.
Telephone Number	:	440-427-1602

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/12/2011

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