Provider Demographics
NPI:1700035763
Name:GLADE, JOHN KENNETH III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNETH
Last Name:GLADE
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:GLADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:10340 W 107TH CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3616
Mailing Address - Country:US
Mailing Address - Phone:303-968-5948
Mailing Address - Fax:303-758-5140
Practice Address - Street 1:720 S COLORADO BLVD
Practice Address - Street 2:162A
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:303-758-3395
Practice Address - Fax:303-758-5140
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor