Provider Demographics
NPI:1205320181
Name:CARKIN, GLEN ROY (MD DC)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:ROY
Last Name:CARKIN
Suffix:
Gender:M
Credentials:MD DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 TURNPIKE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431-1967
Mailing Address - Country:US
Mailing Address - Phone:978-877-1536
Mailing Address - Fax:
Practice Address - Street 1:18 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01469-1300
Practice Address - Country:US
Practice Address - Phone:978-877-1536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor