Provider Demographics
NPI:1275542565
Name:GLASSMAN, DOUGLAS M (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:GLASSMAN
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-0129
Mailing Address - Country:US
Mailing Address - Phone:631-981-2222
Mailing Address - Fax:631-981-2279
Practice Address - Street 1:233 UNION AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1820
Practice Address - Country:US
Practice Address - Phone:631-981-2222
Practice Address - Fax:631-981-2279
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
XFWQT1Medicare PIN