John A Glavin, D.C.
Individual provider Active NPI Chiropractor · Necedah, WI
NPI 1548359482 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1548359482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3265 (WI)
- Practice address
- 209 South Main St.
Necedah, WI 54646-0531 - Phone
- (608) 565-2222
- Fax
- (608) 565-3931
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3265 | WI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3265 | WI | Yes |
Addresses
Primary practice location
209 South Main St.
Necedah, WI 54646-0531
Mailing address
209 South Main St.
P.O. Box 531
Necedah, WI 54646-0531
Phone (608) 565-2222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38889500 | Medicaid | WI |
Other providers in Necedah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.