Provider Demographics
NPI:1184006678
Name:GLYNN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GLYNN CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-401-2238
Mailing Address - Street 1:1105 W PARK AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2567
Mailing Address - Country:US
Mailing Address - Phone:847-401-2238
Mailing Address - Fax:
Practice Address - Street 1:300 E CHURCH ST
Practice Address - Street 2:UNIT 101
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2228
Practice Address - Country:US
Practice Address - Phone:847-401-2238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty