Provider Demographics
NPI:1063859650
Name:GLENN, JOSEPH CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:GLENN
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 1:6401 N INTERSTATE DR STE 148
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-9524
Mailing Address - Country:US
Mailing Address - Phone:405-801-3665
Mailing Address - Fax:913-341-4301
Practice Address - Street 1:6401 N INTERSTATE DR STE 148
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-9524
Practice Address - Country:US
Practice Address - Phone:405-801-3665
Practice Address - Fax:405-801-3666
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05538111N00000X
OK4249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor