Healthcare Provider Details

I. General information

NPI: 1154305837
Provider Name (Legal Business Name): GLENN SCOTT BREITZIG D.C., FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 BERRYWOOD DR
COLUMBIA MO
65201-8372
US

IV. Provider business mailing address

3401 BERRYWOOD DR STE 300
COLUMBIA MO
65201-6515
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8330
  • Fax:
Mailing address:
  • Phone: 573-777-8300
  • Fax: 239-332-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0008078
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019008101
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: