Provider Demographics
NPI:1841412582
Name:NARKIEVICH, GLENN J (DC)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:J
Last Name:NARKIEVICH
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 628
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-0506
Mailing Address - Country:US
Mailing Address - Phone:401-480-3786
Mailing Address - Fax:
Practice Address - Street 1:1775 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4210
Practice Address - Country:US
Practice Address - Phone:401-480-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI44-00099OtherUNITED HEALTHCARE
RIDCP00344OtherLICENSE
RI44-00099OtherUNITED HEALTHCARE