Provider Demographics
NPI:1538256839
Name:SINCLAIR, GLEN EDWARD II (DC)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:EDWARD
Last Name:SINCLAIR
Suffix:II
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 1:1418A GREENSBORO AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2843
Mailing Address - Country:US
Mailing Address - Phone:205-752-1300
Mailing Address - Fax:205-345-5396
Practice Address - Street 1:1418A GREENSBORO AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2843
Practice Address - Country:US
Practice Address - Phone:205-752-1300
Practice Address - Fax:205-345-5396
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2044111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51516303OtherBLUE CROSS IDENTIFIER
ALU96173Medicare UPIN
AL51516303OtherBLUE CROSS IDENTIFIER