Provider Demographics
NPI:1447397914
Name:KREINBROOK, GLENN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:WAYNE
Last Name:KREINBROOK
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 1:320 N FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1114
Mailing Address - Country:US
Mailing Address - Phone:724-238-9740
Mailing Address - Fax:
Practice Address - Street 1:429 MAIN ST
Practice Address - Street 2:APT#10
Practice Address - City:BERLIN
Practice Address - State:PA
Practice Address - Zip Code:15530-1237
Practice Address - Country:US
Practice Address - Phone:814-267-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087929OtherPIN #
PA087929OtherPIN #