Provider Demographics
NPI:1245585645
Name:GLENNON, AUSTIN (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:GLENNON
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 BEACH BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5352
Mailing Address - Country:US
Mailing Address - Phone:407-647-2009
Mailing Address - Fax:
Practice Address - Street 1:730 BEACH BLVD
Practice Address - Street 2:STE 101
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5352
Practice Address - Country:US
Practice Address - Phone:407-647-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-21
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor