Provider Demographics
NPI:1073604724
Name:HAWTHORNE, GLENN GARRISON (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:GARRISON
Last Name:HAWTHORNE
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 1:8701 SHOAL CREEK BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6809
Mailing Address - Country:US
Mailing Address - Phone:512-448-2225
Mailing Address - Fax:512-329-9669
Practice Address - Street 1:8701 SHOAL CREEK BLVD STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6809
Practice Address - Country:US
Practice Address - Phone:512-448-2225
Practice Address - Fax:512-329-9669
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201634928OtherTIN