Provider Demographics
NPI:1295808954
Name:WHITNEY, GLENN HOWARD (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:HOWARD
Last Name:WHITNEY
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:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571-0461
Mailing Address - Country:US
Mailing Address - Phone:516-594-1900
Mailing Address - Fax:516-594-1973
Practice Address - Street 1:1300 WOODFIELD ROAD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4925
Practice Address - Country:US
Practice Address - Phone:516-594-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0088581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X6A231Medicare ID - Type Unspecified
U70283Medicare UPIN