=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538256839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLEN EDWARD SINCLAIR II D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 09/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1418A GREENSBORO AVE
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35401-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-752-1300
-----------------------------------------------------
Fax | 205-345-5396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1418A GREENSBORO AVE
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35401-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-752-1300
-----------------------------------------------------
Fax | 205-345-5396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 2044
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------