Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 012957 | NY |
N | 111NN1001X | Nutrition | 012957 | NY |
NPI | 1639606288 |
---|---|
Provider Name | Dr. Christy Lynn Glidden |
First Address | New York, NY 10016-4325 |
Second Address | New York, NY 10016-4325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2017 |
Last Update Date | 15/05/2017 |