Healthcare Provider Details

I. General information

NPI: 1720088438
Provider Name (Legal Business Name): GLENN KNOBELMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 LANDING RD
LANDING NJ
07850-1504
US

IV. Provider business mailing address

172 LANDING RD
LANDING NJ
07850-1504
US

V. Phone/Fax

Practice location:
  • Phone: 973-398-9330
  • Fax: 973-398-4552
Mailing address:
  • Phone: 973-398-9330
  • Fax: 973-398-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00154600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: