Provider Demographics
NPI:1548277650
Name:TOWERY, GLENN L (DC)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:L
Last Name:TOWERY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 N NAVARRO ST STE A
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1544
Mailing Address - Country:US
Mailing Address - Phone:361-570-6284
Mailing Address - Fax:361-570-6285
Practice Address - Street 1:6412 N NAVARRO ST STE A
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1544
Practice Address - Country:US
Practice Address - Phone:361-570-6284
Practice Address - Fax:361-570-6285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4462197OtherAETNA
TX601516OtherBLUE CROSS/BLUE SHIELD
TX601516OtherBLUE CROSS/BLUE SHIELD
TX4462197OtherAETNA