Provider Demographics
NPI:1942300306
Name:HADLOCK, GLENN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALLEN
Last Name:HADLOCK
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 1:7425 N TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243
Mailing Address - Country:US
Mailing Address - Phone:941-351-3466
Mailing Address - Fax:941-351-3639
Practice Address - Street 1:7425 N TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243
Practice Address - Country:US
Practice Address - Phone:941-351-3466
Practice Address - Fax:941-351-3639
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
70066ZMedicare ID - Type Unspecified
U91967Medicare UPIN