Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2790-L | PA |
NPI | 1083890545 |
---|---|
Provider Name | Dr. Glen Albert Nathan |
First Address | Jenkintown, PA 19046-1420 |
Second Address | Jenkintown, PA 19046-1420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 13/05/2013 |