Provider Demographics
NPI:1356887277
Name:SUPLICKI, MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SUPLICKI
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 1:830 E JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3815
Mailing Address - Country:US
Mailing Address - Phone:614-476-1121
Mailing Address - Fax:
Practice Address - Street 1:830 E JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3815
Practice Address - Country:US
Practice Address - Phone:614-476-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor