Provider Demographics
NPI:1013095546
Name:HELTON, GLENN EDWARD (DC,CCSP)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:EDWARD
Last Name:HELTON
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9004 FOREST XING
Mailing Address - Street 2:STE.C
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1197
Mailing Address - Country:US
Mailing Address - Phone:281-298-5053
Mailing Address - Fax:281-298-7867
Practice Address - Street 1:9004 FOREST XING
Practice Address - Street 2:STE.C
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1197
Practice Address - Country:US
Practice Address - Phone:281-298-5053
Practice Address - Fax:281-298-7867
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8447111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician