MEDICARE: DR. GLEN GILBERT RASMUSSEN 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	3082	SC

General Provider Information

NPI Number	:	1114091022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN GILBERT RASMUSSEN D.C.

Provider Business Mailing Address
First Line	:	11 BERKSHIRE LOOP
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-6349
Country	:	US
Telephone Number	:	843-235-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	1943 GLENNS BAY RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-4833
Country	:	US
Telephone Number	:	843-650-1162
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	04/29/2008

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