Provider Demographics
NPI:1679629794
Name:SORGENFREY, GLENN KENNETH (DC)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:KENNETH
Last Name:SORGENFREY
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 1:1212 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:IA
Mailing Address - Zip Code:52747-9723
Mailing Address - Country:US
Mailing Address - Phone:563-785-6817
Mailing Address - Fax:
Practice Address - Street 1:1212 8TH ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747-9723
Practice Address - Country:US
Practice Address - Phone:563-785-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor