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General NPI Number Information
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NPI Number | 1871946715
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Entity Type | Individual
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Provider Name | JENNIFER S. GLYNN MACOM, L.AC.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 16607 BLANCO RD SUITE 12202
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1913
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Country | US
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Telephone | 210-504-9272
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Fax |
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Provider Business Mailing Address
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Address Line | 17635 HENDERSON PASS APT 922
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1647
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Country | US
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Telephone | 210-504-9272
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01671
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License Number State | TX
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