Healthcare Provider Details

I. General information

NPI: 1225059348
Provider Name (Legal Business Name): GLENN F. GUMAER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 STATE ST STE 101
MEDFORD OR
97504-8498
US

IV. Provider business mailing address

3190 STATE ST STE 101
MEDFORD OR
97504-8498
US

V. Phone/Fax

Practice location:
  • Phone: 541-770-1330
  • Fax: 541-770-7090
Mailing address:
  • Phone: 541-770-1330
  • Fax: 541-770-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27 2941
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: