Provider Demographics
NPI:1104042605
Name:CRIPE, GLENN E (DC)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:E
Last Name:CRIPE
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 1:1501 WESTCLIFF DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5518
Mailing Address - Country:US
Mailing Address - Phone:949-631-5171
Mailing Address - Fax:949-631-6992
Practice Address - Street 1:1501 WESTCLIFF DR STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5518
Practice Address - Country:US
Practice Address - Phone:949-631-5171
Practice Address - Fax:949-631-6992
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC12646Medicare PIN