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General NPI Number Information
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NPI Number | 1801811005
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Entity Type | Individual
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Provider Name | KEVIN SCOTT GLENN D.C.,DABCO
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 23341 GOLDEN SPRINGS DR STE 202
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2054
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Country | US
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Telephone | 909-860-0148
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Fax | 909-860-9348
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Provider Business Mailing Address
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Address Line | 23341 GOLDEN SPRINGS DR STE 202
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2054
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Country | US
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Telephone | 909-860-0148
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Fax | 909-860-9348
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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 | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | DC16390
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License Number State | CA
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