Provider Demographics
NPI:1285657643
Name:GLEN BOBKER DC PA
Entity Type:Organization
Organization Name:GLEN BOBKER DC PA
Other - Org Name:THE DOWNTOWN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-463-1166
Mailing Address - Street 1:1601 EAST BROWARD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2160
Mailing Address - Country:US
Mailing Address - Phone:954-463-1166
Mailing Address - Fax:954-522-6836
Practice Address - Street 1:1601 EAST BROWARD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2160
Practice Address - Country:US
Practice Address - Phone:954-463-1166
Practice Address - Fax:954-522-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T52301Medicare UPIN
22849Medicare ID - Type Unspecified