Provider Demographics
NPI:1326314469
Name:DR GLENN PC
Entity Type:Organization
Organization Name:DR GLENN PC
Other - Org Name:DENVER CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-300-0424
Mailing Address - Street 1:1780 S BELLAIRE ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4351
Mailing Address - Country:US
Mailing Address - Phone:303-300-0424
Mailing Address - Fax:303-648-5456
Practice Address - Street 1:1780 S BELLAIRE ST
Practice Address - Street 2:SUITE 710
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4351
Practice Address - Country:US
Practice Address - Phone:303-300-0424
Practice Address - Fax:303-648-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1689756652Medicare UPIN
CO1205134624Medicare UPIN