Individual
DR. BRYAN C GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
535 LINCOLN WAY W, MISHAWAKA, IN 46544-1800
(574) 255-1716
Mailing address
535 LINCOLN WAY W, MISHAWAKA, IN 46544-1800
(574) 255-1716
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001703A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202168
ANTHEM
IN
05
—
200119230A
—
IN
Enumeration date
09/20/2005
Last updated
11/28/2011
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