Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2094 | OH |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 4237 | KY |
NPI | 1215183793 |
---|---|
Provider Name | Glenn David Dammert |
First Address | Cincinnati, OH 45236-4100 |
Second Address | Cincinnati, OH 45236-4100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 15/08/2008 |