Provider Demographics
NPI:1013015411
Name:POULAIN, GLENN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:THOMAS
Last Name:POULAIN
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 1:3049 UALENA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-834-8662
Mailing Address - Fax:
Practice Address - Street 1:3049 UALENA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1942
Practice Address - Country:US
Practice Address - Phone:808-834-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC806111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology