Provider Demographics
NPI:1467681569
Name:GARLAND D GLENN CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:GARLAND D GLENN CHIROPRACTIC P.C.
Other - Org Name:CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARLAND
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:903-342-5261
Mailing Address - Street 1:PO BOX 8025
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 S MILL ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3125
Practice Address - Country:US
Practice Address - Phone:903-342-5261
Practice Address - Fax:903-342-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty