Provider Demographics
NPI:1548359482
Name:GLAVIN, JOHN A (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:GLAVIN
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 1:209 SOUTH MAIN ST.
Mailing Address - Street 2:P.O. BOX 531
Mailing Address - City:NECEDAH
Mailing Address - State:WI
Mailing Address - Zip Code:54646-0531
Mailing Address - Country:US
Mailing Address - Phone:608-565-2222
Mailing Address - Fax:608-565-3931
Practice Address - Street 1:209 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:NECEDAH
Practice Address - State:WI
Practice Address - Zip Code:54646-0531
Practice Address - Country:US
Practice Address - Phone:608-565-2222
Practice Address - Fax:608-565-3931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38889500Medicaid
WI75033Medicare ID - Type Unspecified