Individual
DR. GLEN T MATEJKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DN DC DACBN CCN
Contact information
Practice address
7105 VIRGINIA RD, SUITE 15, CRYSTAL LAKE, IL 60014-7985
(815) 455-4500
(815) 455-4529
Mailing address
7105 VIRGINIA RD, SUITE 15, CRYSTAL LAKE, IL 60014-7985
(815) 455-4500
(815) 455-4529
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038007434
IL
111NN1001X
Nutrition Chiropractor
164003999
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05605168
BCBS IL
IL
Enumeration date
04/04/2006
Last updated
05/29/2008
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