Provider Demographics
NPI:1225059348
Name:GUMAER, GLENN F (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:F
Last Name:GUMAER
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 1:3190 STATE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8498
Mailing Address - Country:US
Mailing Address - Phone:541-770-1330
Mailing Address - Fax:541-770-7090
Practice Address - Street 1:3190 STATE ST
Practice Address - Street 2:STE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8498
Practice Address - Country:US
Practice Address - Phone:541-770-1330
Practice Address - Fax:541-770-7090
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226598Medicaid
OR226598Medicaid
OR0000QGHFQMedicare PIN