Provider Demographics
NPI:1629110838
Name:BAGER, GLENN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:BAGER
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 1:32 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4068
Mailing Address - Country:US
Mailing Address - Phone:973-887-7832
Mailing Address - Fax:732-827-0018
Practice Address - Street 1:92 STATE RT 27
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2813
Practice Address - Country:US
Practice Address - Phone:732-827-0028
Practice Address - Fax:732-827-0018
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00605200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4-93599Medicare UPIN
NJ0034487Medicare ID - Type Unspecified