Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2852 | TX |
N | 111NN1001X | Nutrition | 2852 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 2852 | TX |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2852 | TX |
NPI | 1346410248 |
---|---|
Provider Name | Dr. Glenn Brady Sand |
First Address | Pasadena, TX 77502-2618 |
Second Address | Pasadena, TX 77502-2618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2008 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
601111 | (02) | TX |