MEDICARE: DR. GLEN'S CHIROPRACTIC HEALTH AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00503500	NJ

General Provider Information

NPI Number	:	1013367630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. GLEN'S CHIROPRACTIC HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	43 OAKLAND AVE
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-1910
Country	:	US
Telephone Number	:	973-699-4161
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 OAKLAND AVE
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-1910
Country	:	US
Telephone Number	:	973-699-4161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GLEN S KATZ
Credential	:
Telephone Number	:	973-699-4161

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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