Provider Demographics
NPI:1518139906
Name:GLENN, ANDREW RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RAYMOND
Last Name:GLENN
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 1:40W201 WASCO RD
Mailing Address - Street 2:STE AB
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-8509
Mailing Address - Country:US
Mailing Address - Phone:847-717-5110
Mailing Address - Fax:
Practice Address - Street 1:40W201 WASCO RD
Practice Address - Street 2:STE AB
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-8509
Practice Address - Country:US
Practice Address - Phone:630-377-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor