Provider Demographics
NPI:1518068170
Name:KNEELAND, GLENN J (DC)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:J
Last Name:KNEELAND
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 1:48 STILES RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2845
Mailing Address - Country:US
Mailing Address - Phone:603-898-0030
Mailing Address - Fax:603-894-6343
Practice Address - Street 1:53 STILES RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2889
Practice Address - Country:US
Practice Address - Phone:603-898-0030
Practice Address - Fax:603-894-6343
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH062-0491-A111N00000X
MA1633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30251660Medicaid
MHU38906Medicare UPIN
NH30251660Medicaid