Glenn Nicholas Collazo, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00430900 Issued in NJ

Practice address

12 Wortendyke Rd
Park Ridge, NJ 07656-2046

Phone

(201) 750-7246

Fax

(201) 497-6614

NPI assigned

Jan 25, 2006

Last updated

Jul 5, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Glenn Nicholas Collazo Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Back Pain Rehab Center for Treatment of Back Pain LLC

  dba Back Pain Rehab LLC

  • Chiropractor
  • Park Ridge, NJ
  • NPI 1639458094
  Authorized official Same address or phone

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309824000000",
    "number": "1376513051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 WORTENDYKE RD",
            "city": "PARK RIDGE",
            "state": "NJ",
            "postal_code": "076562046",
            "telephone_number": "201-750-7246",
            "fax_number": "201-497-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 WORTENDYKE RD",
            "city": "PARK RIDGE",
            "state": "NJ",
            "postal_code": "076562046",
            "telephone_number": "201-750-7246",
            "fax_number": "201-497-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLAZO",
        "first_name": "GLENN",
        "middle_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2011-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00430900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLENN",
            "last_name": "COLLAZO",
            "middle_name": "NICHOLAS",
            "prefix": "DR.",
            "credential": "DC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Dominique Clark, DC
• Elana T Clark, M.D.
• Curalta Medical LLC
• Curalta Medical LLC
• Michele S Cushing-Hennessy, RPH
• Brian T Denichilo, D.M.D.
• Rupam Desai

• Chiropractor in Park Ridge, NJ
• Providers in Park Ridge, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.