Provider Demographics
NPI:1578609608
Name:GRIECO, GLENN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ANTHONY
Last Name:GRIECO
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 1:257 MONMOUTH RD STE 5
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1501
Mailing Address - Country:US
Mailing Address - Phone:732-517-1090
Mailing Address - Fax:732-517-1096
Practice Address - Street 1:257 MONMOUTH RD STE 5
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1501
Practice Address - Country:US
Practice Address - Phone:732-517-1090
Practice Address - Fax:732-517-1096
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00555800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ046288Medicare ID - Type UnspecifiedGROUP
NJ020982PQTMedicare UPIN