Provider Demographics
NPI:1538641303
Name:GLANDER FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:GLANDER FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-235-3807
Mailing Address - Street 1:10920 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2516
Mailing Address - Country:US
Mailing Address - Phone:414-235-3807
Mailing Address - Fax:
Practice Address - Street 1:10920 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2516
Practice Address - Country:US
Practice Address - Phone:414-235-3807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4893-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083046320Medicaid