Provider Demographics
NPI:1013288653
Name:GLENN, CHET (LMT)
Entity Type:Individual
Prefix:
First Name:CHET
Middle Name:
Last Name:GLENN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-233 NANI KAILUA DR
Mailing Address - Street 2:#129
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2033
Mailing Address - Country:US
Mailing Address - Phone:808-329-1830
Mailing Address - Fax:808-329-1830
Practice Address - Street 1:75-233 NANI KAILUA DR
Practice Address - Street 2:#129
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2033
Practice Address - Country:US
Practice Address - Phone:808-329-1830
Practice Address - Fax:808-329-1830
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist