Provider Demographics
NPI:1386717494
Name:NUSBAUM, GLENN C (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:C
Last Name:NUSBAUM
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:7801 MISSION CENTER CT
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1313
Mailing Address - Country:US
Mailing Address - Phone:619-291-1080
Mailing Address - Fax:619-299-2221
Practice Address - Street 1:7801 MISSION CENTER CT
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1313
Practice Address - Country:US
Practice Address - Phone:619-291-1080
Practice Address - Fax:619-299-2221
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20723111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU36742Medicare UPIN