Provider Demographics
NPI:1699870121
Name:GLIVA, STEVE MARK (DC)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:MARK
Last Name:GLIVA
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 1:115 ELM ST STE F
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-1031
Mailing Address - Country:US
Mailing Address - Phone:651-463-7662
Mailing Address - Fax:651-463-4425
Practice Address - Street 1:115 ELM ST STE F
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1031
Practice Address - Country:US
Practice Address - Phone:651-463-7662
Practice Address - Fax:651-463-4425
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2830111N00000X
WI2585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN378728100Medicaid
MN4C527GLOtherBCBS INDIVIDUAL
MN350001310Medicare PIN