Provider Demographics
NPI:1366676843
Name:SKENE, GLENN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JOSEPH
Last Name:SKENE
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 1:17842 IRVINE BLVD
Mailing Address - Street 2:#126
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3203
Mailing Address - Country:US
Mailing Address - Phone:714-336-7049
Mailing Address - Fax:714-486-2302
Practice Address - Street 1:17842 IRVINE BLVD
Practice Address - Street 2:#126
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3203
Practice Address - Country:US
Practice Address - Phone:714-336-7049
Practice Address - Fax:714-486-2302
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor