Provider Demographics
NPI:1942268040
Name:ROBINSON, GLENN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:LEE
Last Name:ROBINSON
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 1:3889 E JAGUAR AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9148
Mailing Address - Country:US
Mailing Address - Phone:480-664-0030
Mailing Address - Fax:480-649-6224
Practice Address - Street 1:525 S GILBERT RD
Practice Address - Street 2:SUITE A-6
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-2930
Practice Address - Country:US
Practice Address - Phone:480-610-6979
Practice Address - Fax:480-649-6224
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7541111N00000X
CA26128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0945570Medicare UPIN
CADC026128Medicare ID - Type Unspecified