Provider Demographics
NPI:1851467567
Name:PHILO, GLEN D (DC)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:D
Last Name:PHILO
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 1:76 NORTHEASTERN BLVD
Mailing Address - Street 2:SUITE 32A
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:603-889-0550
Mailing Address - Fax:603-889-0355
Practice Address - Street 1:76 NORTHEASTERN BLVD
Practice Address - Street 2:SUITE 32A
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062
Practice Address - Country:US
Practice Address - Phone:603-889-0550
Practice Address - Fax:603-889-0355
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2740687B111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30250158Medicaid
000687OtherTUFTS
52190OtherCIGNA
931603OtherAETNA
0501145Y0NH01OtherBCBS
4404302OtherUNITED
NA1719OtherHARVARD
000687OtherTUFTS