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General NPI Number Information
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NPI Number | 1528310877
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Entity Type | Individual
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Provider Name | MATTHEW L GLASS D.C
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Gender | Male
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 1400 MARSH LANDING PKWY STE 107
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-2492
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Country | US
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Telephone | 904-644-3472
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 MARSH LANDING PKWY STE 107
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-2492
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Country | US
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Telephone | 917-595-9061
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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 | X012784-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH13651
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License Number State | FL
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