Provider Demographics
NPI:1932289469
Name:BARNES, GLENN ALLEN (DC,)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ALLEN
Last Name:BARNES
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 1:9021 N 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4210
Mailing Address - Country:US
Mailing Address - Phone:623-939-7509
Mailing Address - Fax:623-939-7500
Practice Address - Street 1:9021 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4210
Practice Address - Country:US
Practice Address - Phone:623-939-7509
Practice Address - Fax:623-939-7500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0085160OtherBCBS
AZ860417002OtherTAX ID
AZAZ0085160OtherBCBS
AZT41374Medicare UPIN