Individual
DR. GLEN PETCAVAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1225 REDWOOD ST, FORT COLLINS, CO 80524-2052
(970) 484-2023
(866) 867-8553
Mailing address
1225 REDWOOD ST, FORT COLLINS, CO 80524-2052
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHR-6164
CO
Other
Enumeration date
04/08/2010
Last updated
04/08/2010
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