Provider Demographics
NPI:1114076726
Name:GLOW, DUANE A (DC)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:A
Last Name:GLOW
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 1:1259 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1813
Mailing Address - Country:US
Mailing Address - Phone:978-582-6600
Mailing Address - Fax:978-582-6851
Practice Address - Street 1:1259 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-1813
Practice Address - Country:US
Practice Address - Phone:978-582-6600
Practice Address - Fax:978-582-6851
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 1543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT98232Medicare UPIN
MAY36076Medicare ID - Type Unspecified