MEDICARE: DR. GLENN SCOTT BREITZIG D.C., FNP-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	CH0008078	FL
2	363LF0000X	Family Nurse Practitioner	2019008101	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154305837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN SCOTT BREITZIG D.C., FNP-C

Provider Business Mailing Address
First Line	:	3401 BERRYWOOD DR STE 300
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-6515
Country	:	US
Telephone Number	:	573-777-8300
Fax Number	:	239-332-2145

Provider Business Practice Location Address
First Line	:	1300 E BRADFORD PKWY
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4294
Country	:	US
Telephone Number	:	417-761-5000
Fax Number	:	417-761-5011

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	04/24/2019

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