Provider Demographics
NPI:1619070695
Name:COCHRANE, GLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:
Last Name:COCHRANE
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 1:4616 W SAHARA AVE # 337
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3654
Mailing Address - Country:US
Mailing Address - Phone:702-880-4193
Mailing Address - Fax:702-880-4197
Practice Address - Street 1:3835 S JONES BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2283
Practice Address - Country:US
Practice Address - Phone:702-880-4193
Practice Address - Fax:702-880-4197
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV1002229Medicare ID - Type Unspecified