MEDICARE: DR. BRIAN CLANCY VETTER D.C.

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	X011506-1	NY
2	111N00000X	Chiropractor	4131	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689877227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN CLANCY VETTER D.C.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	10/07/2014

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