Provider Demographics
NPI:1154459147
Name:EIGENMANN, GLENN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:SCOTT
Last Name:EIGENMANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MILLERS LN
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9500
Mailing Address - Country:US
Mailing Address - Phone:973-334-1793
Mailing Address - Fax:
Practice Address - Street 1:139 MORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2606
Practice Address - Country:US
Practice Address - Phone:908-221-0808
Practice Address - Fax:908-221-9024
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00312000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor