MEDICARE: DR. DAVID MARK GLICK D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	0104000858	VA
2	111NN0400X	Neurology Chiropractor	F--0000526	DE
3	111NN0400X	Neurology Chiropractor	38MC00446700	NJ

General Provider Information

NPI Number	:	1073651725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MARK GLICK D.C

Provider Business Mailing Address
First Line	:	PO BOX 2597
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-9115
Country	:	US
Telephone Number	:	804-327-0084
Fax Number	:	866-602-1146

Provider Business Practice Location Address
First Line	:	7329 BOULDER VIEW LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4953
Country	:	US
Telephone Number	:	804-327-0084
Fax Number	:	866-602-1146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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