Provider Demographics
NPI:1568599751
Name:BERKELEY, GLENN BRADFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:BRADFORD
Last Name:BERKELEY
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 1:1922 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3327 SUPERIOR LN
Practice Address - Street 2:SUITE 204
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1922
Practice Address - Country:US
Practice Address - Phone:301-860-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor