Provider Demographics
NPI:1598817769
Name:GLENN, DEBORAH S I (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S I
Last Name:GLENN
Suffix:
Gender:F
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:PO BOX 1768
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-8768
Mailing Address - Country:US
Mailing Address - Phone:808-262-2099
Mailing Address - Fax:808-263-9720
Practice Address - Street 1:415 ULUNIU ST STE D
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2503
Practice Address - Country:US
Practice Address - Phone:808-262-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91053Medicare UPIN
HIH54739Medicare ID - Type Unspecified