Healthcare Provider Details

I. General information

NPI: 1295808954
Provider Name (Legal Business Name): GLENN HOWARD WHITNEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WOODFIELD ROAD
ROCKVILLE CENTRE NY
11570-4925
US

IV. Provider business mailing address

PO BOX 461
ROCKVILLE CENTRE NY
11571-0461
US

V. Phone/Fax

Practice location:
  • Phone: 516-594-1900
  • Fax:
Mailing address:
  • Phone: 516-594-1900
  • Fax: 516-594-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0088581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: