Provider Demographics
NPI:1083690887
Name:SUMMERS, GLENDON CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENDON
Middle Name:CARL
Last Name:SUMMERS
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:RR 2 BOX 110A5
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-9631
Mailing Address - Country:US
Mailing Address - Phone:570-465-9485
Mailing Address - Fax:570-465-9485
Practice Address - Street 1:RR 2 BOX 110A5
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-9631
Practice Address - Country:US
Practice Address - Phone:570-465-9485
Practice Address - Fax:570-465-9485
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006261L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA347742OtherMVP
PA01552199Medicaid
PA808399OtherFIRST PRIORITY HEALTH
PA10068668OtherCDPHP
PA832891OtherAETNA
PA10068668OtherCDPHP
PAU57804Medicare UPIN