Healthcare Provider Details

I. General information

NPI: 1538256839
Provider Name (Legal Business Name): GLEN EDWARD SINCLAIR II D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418A GREENSBORO AVE
TUSCALOOSA AL
35401-2843
US

IV. Provider business mailing address

1418A GREENSBORO AVE
TUSCALOOSA AL
35401-2843
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-1300
  • Fax: 205-345-5396
Mailing address:
  • Phone: 205-752-1300
  • Fax: 205-345-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2044
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: