Provider Demographics
NPI:1518093665
Name:BOBKER, GLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:
Last Name:BOBKER
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 1:1601 E BROWARD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2160
Mailing Address - Country:US
Mailing Address - Phone:954-463-1166
Mailing Address - Fax:954-522-6836
Practice Address - Street 1:1601 E BROWARD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2160
Practice Address - Country:US
Practice Address - Phone:954-463-1166
Practice Address - Fax:954-522-6836
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT52301Medicare UPIN
FL22849Medicare ID - Type Unspecified