Provider Demographics
NPI:1922197284
Name:KATZ, GLEN (DC)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:KATZ
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 1:415 SPEEDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2100
Mailing Address - Country:US
Mailing Address - Phone:973-359-3055
Mailing Address - Fax:973-359-3056
Practice Address - Street 1:415 SPEEDWELL AVE
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2100
Practice Address - Country:US
Practice Address - Phone:973-359-3055
Practice Address - Fax:973-359-3056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00503500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ906717Medicare ID - Type Unspecified