MEDICARE: GLENN D BEHRMAN 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	CH6175	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22513	OTHER	FL	BLUE CROSS BLUE SHEILD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548317506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN D BEHRMAN D.C.

Provider Business Mailing Address
First Line	:	1054 S BUENA VISTA DR
Second Line	:
City	:	LAKE ALFRED
State	:	FL
Zip	:	33850-3408
Country	:	US
Telephone Number	:	863-956-1458
Fax Number	:

Provider Business Practice Location Address
First Line	:	1054 S BUENA VISTA DR
Second Line	:
City	:	LAKE ALFRED
State	:	FL
Zip	:	33850-3408
Country	:	US
Telephone Number	:	863-956-1458
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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