Provider Demographics
NPI:1184771081
Name:HENSLE, GLENN J (LAC, QME)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:J
Last Name:HENSLE
Suffix:
Gender:M
Credentials:LAC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3821 ATLANTIC AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3533
Mailing Address - Country:US
Mailing Address - Phone:562-490-0400
Mailing Address - Fax:562-490-0440
Practice Address - Street 1:3821 ATLANTIC AVE
Practice Address - Street 2:SUITE F
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3533
Practice Address - Country:US
Practice Address - Phone:562-490-0400
Practice Address - Fax:562-490-0440
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC7413OtherACUPUNCTURE LICENSE NO.