Active NPI
Glynn Chiropractic, Inc.
- Chiropractor
- Libertyville, IL
National Provider Identifier
1184006678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038012141
- 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, 2015
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151002002307 | IL | Part B Supplier - Clinic/Group Practice | 0749598274 | Practice locations: Libertyville, IL |
National Provider Directory
National Provider DirectoryNPI 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.