MEDICARE: WADE GLENN CLINGAN 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	1948	AL

General Provider Information

NPI Number	:	1811908247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WADE GLENN CLINGAN D.C.

Provider Business Mailing Address
First Line	:	550 MCQUEEN SMITH RD N
Second Line	:
City	:	PRATTVILLE
State	:	AL
Zip	:	36066-5558
Country	:	US
Telephone Number	:	334-358-0320
Fax Number	:	334-358-8923

Provider Business Practice Location Address
First Line	:	550 MCQUEEN SMITH RD N
Second Line	:
City	:	PRATTVILLE
State	:	AL
Zip	:	36066-5558
Country	:	US
Telephone Number	:	334-358-0320
Fax Number	:	334-358-8923

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/10/2023

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