Provider Demographics
NPI:1033535349
Name:GLENN K. ROBINSON DC PC
Entity Type:Organization
Organization Name:GLENN K. ROBINSON DC PC
Other - Org Name:CAIRO CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-377-9064
Mailing Address - Street 1:2807 HWY 84 EAST
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828
Mailing Address - Country:US
Mailing Address - Phone:229-377-9064
Mailing Address - Fax:229-377-3926
Practice Address - Street 1:2807 HWY 84 EAST
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:31728
Practice Address - Country:US
Practice Address - Phone:229-377-9064
Practice Address - Fax:229-377-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00851188AMedicaid
GA202G709386Medicare PIN
GA00851188AMedicaid