Provider Demographics
NPI:1114511805
Name:BRASSEUR, GLEN ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:ALLAN
Last Name:BRASSEUR
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 1:1782 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3972
Mailing Address - Country:US
Mailing Address - Phone:510-333-1670
Mailing Address - Fax:
Practice Address - Street 1:1782 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3972
Practice Address - Country:US
Practice Address - Phone:510-333-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6196111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6196OtherLICENSE NUMBER