Provider Demographics
NPI:1992828925
Name:MELTZER, GLENN (DO)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:MELTZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 TUNXIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4412
Mailing Address - Country:US
Mailing Address - Phone:203-334-3660
Mailing Address - Fax:203-334-3669
Practice Address - Street 1:FAIRFIELD CHIROPRACTIC & WELLNESS CENTER
Practice Address - Street 2:540 TUNXIS HILL ROAD
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825
Practice Address - Country:US
Practice Address - Phone:203-334-3660
Practice Address - Fax:203-334-3669
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001468CT02Medicare UPIN