MEDICARE: DR. GLENN STUART MULLER 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	0104000474	VA

General Provider Information

NPI Number	:	1447312756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN STUART MULLER D.C.

Provider Business Mailing Address
First Line	:	2200 BOULEVARD
Second Line	:	SUITE C
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2305
Country	:	US
Telephone Number	:	804-520-7246
Fax Number	:	804-520-6311

Provider Business Practice Location Address
First Line	:	2200 BOULEVARD
Second Line	:	SUITE C
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2305
Country	:	US
Telephone Number	:	804-520-7246
Fax Number	:	804-520-6311

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/20/2012

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