Provider Demographics
NPI:1588789234
Name:GLINES, CHAD EVERETT (DC)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:EVERETT
Last Name:GLINES
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 1:2306 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-3219
Mailing Address - Country:US
Mailing Address - Phone:361-643-3298
Mailing Address - Fax:
Practice Address - Street 1:4002 JOHN STOCKBAUER DR STE A
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2452
Practice Address - Country:US
Practice Address - Phone:361-570-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor