Provider Demographics
NPI:1144230376
Name:GLAUS, BRIAN L (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:GLAUS
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 1:2220 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2704
Mailing Address - Country:US
Mailing Address - Phone:563-355-3100
Mailing Address - Fax:888-773-3960
Practice Address - Street 1:2220 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2704
Practice Address - Country:US
Practice Address - Phone:563-355-3100
Practice Address - Fax:888-773-3960
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU65853Medicare UPIN
IL211039Medicare ID - Type UnspecifiedMEDICARE GROUP
ILK15631Medicare ID - Type UnspecifiedMEDICARE