Physician Compare National (NPI:1497310585)

HEALTHCARE PROVIDER: TANNER SAMUEL GLASS DC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1497310585
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204165079
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190904003338
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GLASS
	Individual professional last name
Provider First Name	TANNER
	Individual professional first name
Provider Middle Name	SAMUEL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LIFE CHIROPRACTIC COLLEGE
	Individual professional's medical school
Graduation Year	2019
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	401 HUGHES RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	MADISON
	Group Practice or individual's city
State	AL
	Group Practice or individual's state
Zip Code	357581144
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M