Provider Demographics
NPI:1942866769
Name:GLENN, RAEMARIS (DC)
Entity Type:Individual
Prefix:
First Name:RAEMARIS
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:RAEMARIS
Other - Middle Name:
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5101 NE 48TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2844
Mailing Address - Country:US
Mailing Address - Phone:520-647-1895
Mailing Address - Fax:
Practice Address - Street 1:5101 NE 48TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2844
Practice Address - Country:US
Practice Address - Phone:520-647-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
WACH61001091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty