Provider Demographics
NPI:1447312756
Name:MULLER, GLENN STUART (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:STUART
Last Name:MULLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 BOULEVARD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2305
Mailing Address - Country:US
Mailing Address - Phone:804-520-7246
Mailing Address - Fax:804-520-6311
Practice Address - Street 1:2200 BOULEVARD
Practice Address - Street 2:SUITE C
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2305
Practice Address - Country:US
Practice Address - Phone:804-520-7246
Practice Address - Fax:804-520-6311
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA21367Medicare UPIN