# MR. GLEN E ROOYAKKERS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1568572477
- **Gender:** Man
- **Credential:** DC DACNB

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 2603 012 | WI | Yes |
| 111NN0400X | Neurology Chiropractor | 2603 012 | WI | — |
| 111NS0005X | Sports Physician Chiropractor | 2603 012 | WI | — |

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 07/14/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 38848900 | — | WI |