1518068170 NPI number — MR. GLENN J KNEELAND D.C.

Table of content: MR. GLENN J KNEELAND D.C. (NPI 1518068170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518068170 NPI number — MR. GLENN J KNEELAND D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNEELAND
Provider First Name:
GLENN
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518068170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 STILES RD
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03079-2845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-898-0030
Provider Business Mailing Address Fax Number:
603-894-6343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 STILES RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03079-2889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-898-0030
Provider Business Practice Location Address Fax Number:
603-894-6343
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  062-0491-A , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 1633 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30251660 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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