Provider Demographics
NPI:1851793087
Name:GLENN, JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
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 1:2110 SW COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7180
Mailing Address - Country:US
Mailing Address - Phone:515-710-0096
Mailing Address - Fax:
Practice Address - Street 1:1711 SW PLAZA PKWY
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7013
Practice Address - Country:US
Practice Address - Phone:515-964-2322
Practice Address - Fax:515-224-5140
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007738111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician