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General NPI Number Information
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NPI Number | 1598910648
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Entity Type | Organization
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Legal Business Name | GLEN HAYWOOD DC PC
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 107 N GUN BARREL LN
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-3724
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Country | US
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Telephone | 903-887-1417
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 242
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City | MABANK
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State | TX
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Zip | 75147-0242
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Country | US
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Telephone | 903-887-1417
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GLEN HAYWOOD
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Credential | DC PC
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Telephone | 903-887-1417
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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 | 2459
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License Number State | TX
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