Provider Demographics
NPI:1275719908
Name:ASTI, GLENN J (DC)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:J
Last Name:ASTI
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 1:1052 NW NEWPORT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1679
Mailing Address - Country:US
Mailing Address - Phone:541-330-5737
Mailing Address - Fax:541-382-1944
Practice Address - Street 1:1052 NW NEWPORT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1679
Practice Address - Country:US
Practice Address - Phone:541-330-5737
Practice Address - Fax:541-330-5737
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR153639Medicare PIN