Provider Demographics
NPI:1295778637
Name:GLANZER, BARRY (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:GLANZER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6468
Mailing Address - Country:US
Mailing Address - Phone:208-523-0121
Mailing Address - Fax:208-529-0001
Practice Address - Street 1:1880 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6468
Practice Address - Country:US
Practice Address - Phone:208-523-0121
Practice Address - Fax:208-529-0001
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-6079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1674655Medicare ID - Type UnspecifiedCIGNA - MEDICARE
IDU40593Medicare UPIN