Organization Active NPI

Glynn Chiropractic, Inc.

  • Chiropractor
  • Libertyville, IL
National Provider Identifier
1184006678
Registry record updated Jun 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038012141 Issued in IL
Legal business name
GLYNN CHIROPRACTIC, INC.
Practice address
300 E Church St
Unit 101
Libertyville, IL 60048-2228
Phone
(847) 401-2238
NPI assigned
Jun 22, 2015
Last updated
Jun 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ryan Alexander Glynn, D.C.
Title
Doctor of Chiropractic
Phone
(847) 401-2238

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038012141 IL Primary

Addresses

Primary practice location

300 E Church St
Unit 101
Libertyville, IL 60048-2228

Mailing address

1105 W Park Ave
Suite 7
Libertyville, IL 60048-2567
Phone (847) 401-2238

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151002002307 IL Part B Supplier - Clinic/Group Practice 0749598274 Practice locations: Libertyville, IL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1184006678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 W PARK AVE",
            "address_2": "SUITE 7",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482567",
            "telephone_number": "847-401-2238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E CHURCH ST",
            "address_2": "UNIT 101",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482228",
            "telephone_number": "847-401-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLYNN CHIROPRACTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-22",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "GLYNN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "847-401-2238",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038012141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.