Provider Demographics
NPI:1083787659
Name:KRIEGER, GLENN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:KRIEGER
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 611
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-0611
Mailing Address - Country:US
Mailing Address - Phone:914-698-9283
Mailing Address - Fax:914-698-9436
Practice Address - Street 1:1600 HARRISON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3145
Practice Address - Country:US
Practice Address - Phone:914-698-9283
Practice Address - Fax:914-698-9436
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5V43OtherBLUE CROSS BLUE SHIELD
NY5897815OtherGHI
NYP2981383OtherOXFORD
NYX5C551OtherMEDICARE PTAN
NY652644OtherACN