MEDICARE: GLENN DAVID DAMMERT DC

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	2094	OH
2	111NX0800X	Orthopedic Chiropractor	4237	KY

General Provider Information

NPI Number	:	1215183793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN DAVID DAMMERT DC

Provider Business Mailing Address
First Line	:	7450 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-4100
Country	:	US
Telephone Number	:	513-791-3633
Fax Number	:

Provider Business Practice Location Address
First Line	:	7450 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-4100
Country	:	US
Telephone Number	:	513-791-3633
Fax Number	:

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

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	08/15/2008

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Directions to “ GLENN DAVID DAMMERT DC” Practice Location

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