Provider Demographics
NPI:1801901491
Name:BAUMAN, GLENN DARRELL (DC)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:DARRELL
Last Name:BAUMAN
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 1:519 S MAPLE
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1427
Mailing Address - Country:US
Mailing Address - Phone:785-448-2422
Mailing Address - Fax:785-448-2427
Practice Address - Street 1:519 S MAPLE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1427
Practice Address - Country:US
Practice Address - Phone:785-448-2422
Practice Address - Fax:785-448-2427
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7005674OtherAETNA
KS062219OtherBCBS
KS7005674OtherAETNA
KS062219Medicare ID - Type Unspecified