MEDICARE: DR. GLEN BOBKER 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	CH6552	FL

General Provider Information

NPI Number	:	1518093665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN BOBKER D.C.

Provider Business Mailing Address
First Line	:	1601 E BROWARD BLVD
Second Line	:	SUITE B
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2160
Country	:	US
Telephone Number	:	954-463-1166
Fax Number	:	954-522-6836

Provider Business Practice Location Address
First Line	:	1601 E BROWARD BLVD
Second Line	:	SUITE B
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2160
Country	:	US
Telephone Number	:	954-463-1166
Fax Number	:	954-522-6836

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

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	07/08/2007

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