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General NPI Number Information
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NPI Number | 1285657643
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Entity Type | Organization
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Legal Business Name | GLEN BOBKER DC PA
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1601 EAST BROWARD BLVD SUITE B
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2160
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Country | US
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Telephone | 954-463-1166
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Fax | 954-522-6836
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Provider Business Mailing Address
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Address Line | 1601 EAST BROWARD BLVD SUITE B
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2160
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Country | US
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Telephone | 954-463-1166
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Fax | 954-522-6836
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLEN BOBKER
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Credential | DC
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Telephone | 954-463-1166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH6552
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License Number State | FL
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