Basic Information
| Provider Information | |||||||||
| NPI: | 1629110838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGER | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 NORMANDY DR | ||||||||
| Address2: | |||||||||
| City: | PARSIPPANY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070544068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738877832 | ||||||||
| FaxNumber: | 7328270018 | ||||||||
| Practice Location | |||||||||
| Address1: | 92 STATE RT 27 | ||||||||
| Address2: | |||||||||
| City: | RAHWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070652813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328270028 | ||||||||
| FaxNumber: | 7328270018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 38MC00605200 | NJ | Y | Chiropractic Providers | Chiropractor |
No ID Information.