Provider Demographics
NPI:1780991000
Name:MILLER, GLENN R (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2901 DRUID PARK DR STE 106
Mailing Address - Street 2:ASHBURTON CHIROPRACTIC
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-8172
Mailing Address - Country:US
Mailing Address - Phone:410-669-5555
Mailing Address - Fax:410-669-5757
Practice Address - Street 1:2901 DRUID PARK DR STE 106
Practice Address - Street 2:ASHBURTON CHIROPRACTIC
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-8172
Practice Address - Country:US
Practice Address - Phone:410-669-5555
Practice Address - Fax:410-669-5757
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD1232111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11-3701080OtherEIN