Provider Demographics
NPI:1942325550
Name:GLUBKA, LARRY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOHN
Last Name:GLUBKA
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 1:901 W CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2837
Mailing Address - Country:US
Mailing Address - Phone:541-746-4122
Mailing Address - Fax:
Practice Address - Street 1:901 W CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2837
Practice Address - Country:US
Practice Address - Phone:541-746-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor