Provider Demographics
NPI:1174655328
Name:GLYNN, MARK D (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:GLYNN
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 1:1995 SPRINGBROOK SQUARE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5952
Mailing Address - Country:US
Mailing Address - Phone:630-922-6500
Mailing Address - Fax:630-922-6502
Practice Address - Street 1:1995 SPRINGBROOK SQUARE DR STE 109
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5952
Practice Address - Country:US
Practice Address - Phone:630-922-6500
Practice Address - Fax:630-922-6502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212347Medicare ID - Type UnspecifiedMEDICARE
IL202490134Medicare UPIN
IL02232722Medicare UPIN