MEDICARE: DR. GLENN RAYMOND DOOLEY DC

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	6986	TX

General Provider Information

NPI Number	:	1831298868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN RAYMOND DOOLEY DC

Provider Business Mailing Address
First Line	:	3701 W NW HWY
Second Line	:	#235
City	:	DALLAS
State	:	TX
Zip	:	75220
Country	:	US
Telephone Number	:	214-366-1133
Fax Number	:	214-366-3916

Provider Business Practice Location Address
First Line	:	3701 W NW HWY
Second Line	:	#235
City	:	DALLAS
State	:	TX
Zip	:	75220
Country	:	US
Telephone Number	:	214-366-1133
Fax Number	:	214-366-3916

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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