Individual
DR. GARLAND DWAIN GLENN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
11710 PLAZA AMERICA DR STE 2000, RESTON, VA 20190-4743
(703) 303-8844
Mailing address
11509 HEMINGWAY DR, RESTON, VA 20194-1240
(703) 303-8844
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104557290
VA
111N00000X
Chiropractor
9612
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
753118466
BLUE CROSS BLUE SHIELD #
SC
Enumeration date
03/17/2006
Last updated
10/31/2018
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