Provider Demographics
NPI:1598718629
Name:MACWHORTER, GLENN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EDWARD
Last Name:MACWHORTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1525 CALYPSO DR.
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-479-1213
Mailing Address - Fax:831-479-1016
Practice Address - Street 1:716 CAPITOLA AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2777
Practice Address - Country:US
Practice Address - Phone:831-479-1213
Practice Address - Fax:831-479-1016
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13598111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05074Medicare UPIN