Provider Demographics
NPI:1801120878
Name:GLENN FAMILY CHIROPRACTIC, PA
Entity type:Organization
Organization Name:GLENN FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-712-2800
Mailing Address - Street 1:9741 PRESTON RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2585
Mailing Address - Country:US
Mailing Address - Phone:972-712-2800
Mailing Address - Fax:
Practice Address - Street 1:9741 PRESTON RD
Practice Address - Street 2:STE. 101
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-2585
Practice Address - Country:US
Practice Address - Phone:972-712-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11204261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service