MEDICARE: DR. GLENN JOHN HOFFMAN D.C.

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	1698-012	WI

General Provider Information

NPI Number	:	1063412476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN JOHN HOFFMAN D.C.

Provider Business Mailing Address
First Line	:	1841 S RIDGE RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-3938
Country	:	US
Telephone Number	:	920-498-3611
Fax Number	:	920-498-3611

Provider Business Practice Location Address
First Line	:	1841 S RIDGE RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-3938
Country	:	US
Telephone Number	:	920-498-3611
Fax Number	:	920-498-3611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/14/2011

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