MEDICARE: GLENN CHIROPRACTIC

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	01-05538	KS

General Provider Information

NPI Number	:	1730590357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	8016 STATE LINE RD STE 100
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3713
Country	:	US
Telephone Number	:	785-764-9200
Fax Number	:	913-341-4301

Provider Business Practice Location Address
First Line	:	8016 STATE LINE RD STE 100
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3713
Country	:	US
Telephone Number	:	785-764-9200
Fax Number	:	913-341-4301

Authorized Official
Title or Position	:	CHIROPRACTIC PRACTITIONER
Name	:	DR. JOSEPH CHARLES GLENN
Credential	:	D.C.
Telephone Number	:	785-764-9200

Provider Enumeration Date	:	05/16/2014
Last Update Date	:	05/16/2014

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Directions to “GLENN CHIROPRACTIC ” Practice Location

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