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General NPI Number Information
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NPI Number | 1992935720
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Entity Type | Individual
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Provider Name | RICHARD LEE GLENN D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 100 E LINDA VISTA BLVD
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City | ROSWELL
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State | NM
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Zip | 88201-6654
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Country | US
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Telephone | 575-623-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 401 N UNION AVE
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City | ROSWELL
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State | NM
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Zip | 88201-3948
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Country | US
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Telephone | 575-623-2900
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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 | 11204
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1909
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License Number State | NM
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