Provider Demographics
NPI:1629071568
Name:IZOR, GLENN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EDWARD
Last Name:IZOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7235 SAWMILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-5003
Mailing Address - Country:US
Mailing Address - Phone:614-764-8780
Mailing Address - Fax:614-764-7415
Practice Address - Street 1:7235 SAWMILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-5003
Practice Address - Country:US
Practice Address - Phone:614-764-8780
Practice Address - Fax:614-764-7415
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310974498-00OtherWORKER'S COMPENSATION
OHP00198927OtherRAILROAD MEDICARE
OH0580894Medicaid
OH310974498-00OtherWORKER'S COMPENSATION
OHP00198927OtherRAILROAD MEDICARE