Provider Demographics
NPI:1629337456
Name:GLENN ENTERPRISES, A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:GLENN ENTERPRISES, A CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-321-7193
Mailing Address - Street 1:480 CALIFORNIA AVE.
Mailing Address - Street 2:#103
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306
Mailing Address - Country:US
Mailing Address - Phone:650-321-7193
Mailing Address - Fax:877-763-3234
Practice Address - Street 1:480 CALIFORNIA AVE.
Practice Address - Street 2:#103
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306
Practice Address - Country:US
Practice Address - Phone:650-321-7193
Practice Address - Fax:877-763-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty