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General NPI Number Information
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NPI Number | 1386466431
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Entity Type | Individual
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Provider Name | JACOB STEWART GLEN DC
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Gender | Male
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 975 AIRPORT RD SW STE H
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City | HUNTSVILLE
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State | AL
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Zip | 35802-1395
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Country | US
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Telephone | 256-203-4275
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 BRETT RD NW
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City | HUNTSVILLE
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State | AL
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Zip | 35810-3304
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Country | US
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Telephone | 804-516-2450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2877
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License Number State | AL
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