Provider Demographics
NPI:1477631976
Name:LEVY, GLENN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:RICHARD
Last Name:LEVY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:GLENN
Other - Middle Name:RICHARD
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1895 PLUMAS ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3384
Mailing Address - Country:US
Mailing Address - Phone:775-322-5389
Mailing Address - Fax:
Practice Address - Street 1:1895 PLUMAS ST STE 3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3384
Practice Address - Country:US
Practice Address - Phone:775-322-5389
Practice Address - Fax:775-826-8466
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV603614001Medicaid
NV603614001Medicaid