Individual
DR. GLENN C WILLARETH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
118 E JACKSON ST, MORRIS, IL 60450-1891
(815) 942-5350
(815) 942-5414
Mailing address
118 E JACKSON ST, MORRIS, IL 60450-1891
(815) 942-5350
(815) 942-5414
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0380003315
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3282001
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
04/21/2006
Last updated
07/08/2007
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