Provider Demographics
NPI:1346219391
Name:GLASS, RUSTIN W (DC)
Entity Type:Individual
Prefix:
First Name:RUSTIN
Middle Name:W
Last Name:GLASS
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 1:900B CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1416
Mailing Address - Country:US
Mailing Address - Phone:717-898-8900
Mailing Address - Fax:717-898-6009
Practice Address - Street 1:900B CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1416
Practice Address - Country:US
Practice Address - Phone:717-898-8900
Practice Address - Fax:717-898-6009
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00231877OtherRAILROAD EDICARE
PA50003718OtherCAPITAL BLUE CROSS
PA610846400OtherUSPS WORKMAN'S COMP
PAAD1775455OtherHIGHMARK BLUE SHIELD
PAKEYSTONE EASTOther2104754000
PA1190412OtherAETNA
PAP00231877OtherRAILRAOD MEDICARE
PA1190412OtherAETNA
PA062269UXFMedicare PIN