Provider Demographics
NPI:1760523302
Name:PERRYMAN, GLENN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JAMES
Last Name:PERRYMAN
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 1:15520 ROCKFIELD BLVD A200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:28281 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE# 100
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1498
Practice Address - Country:US
Practice Address - Phone:949-367-0407
Practice Address - Fax:949-367-0406
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABJ282OtherPTAN
CADC28276OtherCHIROPRACTIC LICENSE