Provider Demographics
NPI:1073651725
Name:GLICK, DAVID MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:GLICK
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:PO BOX 2597
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9115
Mailing Address - Country:US
Mailing Address - Phone:804-327-0084
Mailing Address - Fax:866-602-1146
Practice Address - Street 1:7329 BOULDER VIEW LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4953
Practice Address - Country:US
Practice Address - Phone:804-327-0084
Practice Address - Fax:866-602-1146
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000858111NN0400X
DEF--0000526111NN0400X
NJ38MC00446700111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology