Provider Demographics
NPI:1871930610
Name:BRIAN G. SUPPLEE, D.C., INC.
Entity type:Organization
Organization Name:BRIAN G. SUPPLEE, D.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SUPPLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-306-5696
Mailing Address - Street 1:2545 PETZINGER RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3498
Mailing Address - Country:US
Mailing Address - Phone:614-338-1440
Mailing Address - Fax:614-338-1450
Practice Address - Street 1:2545 PETZINGER RD
Practice Address - Street 2:SUITE K
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3498
Practice Address - Country:US
Practice Address - Phone:614-338-1440
Practice Address - Fax:614-338-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty