Individual
DR. GLENN JAY PEDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
650 N GOSPEL ST STE 4, PAOLI, IN 47454-1482
(812) 252-2225
(833) 336-4142
Mailing address
650 N GOSPEL ST, PAOLI, IN 47454-1483
(812) 252-2225
(833) 336-4142
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08000852A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01682626
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/28/2006
Last updated
05/21/2025
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