Provider Demographics
NPI:1790032068
Name:GLENN, ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:GLENN
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 1:1807D SANTA RITA RD # 128
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4725
Mailing Address - Country:US
Mailing Address - Phone:510-397-7463
Mailing Address - Fax:
Practice Address - Street 1:480 S CALIFORNIA AVE
Practice Address - Street 2:STE 103
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1623
Practice Address - Country:US
Practice Address - Phone:650-321-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor