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General NPI Number Information
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NPI Number | 1881953784
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Entity Type | Individual
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Provider Name | GLENNIA J CHITWOOD D.C.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 16925 MANCHESTER RD SUITE 1
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City | WILDWOOD
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State | MO
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Zip | 63040
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Country | US
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Telephone | 636-489-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 16111 MANCHESTER RD STE 202
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City | ELLISVILLE
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State | MO
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Zip | 63011-2489
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Country | US
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Telephone | 636-489-1616
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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 | 2012013553
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License Number State | MO
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