Provider Demographics
NPI:1740200740
Name:KAIN, GLEN E (DC)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:E
Last Name:KAIN
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 1:176 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1941
Mailing Address - Country:US
Mailing Address - Phone:740-344-4447
Mailing Address - Fax:740-344-3346
Practice Address - Street 1:176 S 30TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1941
Practice Address - Country:US
Practice Address - Phone:740-344-4447
Practice Address - Fax:740-344-3346
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0231681Medicaid
OH0802421Medicare ID - Type Unspecified
OH0231681Medicaid