Provider Demographics
NPI:1497710156
Name:SIEGEL, GLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:
Last Name:SIEGEL
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 1:7963 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5877
Mailing Address - Country:US
Mailing Address - Phone:954-966-8770
Mailing Address - Fax:954-966-8770
Practice Address - Street 1:7963 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5877
Practice Address - Country:US
Practice Address - Phone:954-966-8770
Practice Address - Fax:954-966-8770
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55718Medicare UPIN
FL88156AMedicare ID - Type Unspecified