Provider Demographics
NPI:1962650929
Name:GLAVAN, ROBERT (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GLAVAN
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 1:454 W SANILAC RD
Mailing Address - Street 2:P.O. BOX 289
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1065
Mailing Address - Country:US
Mailing Address - Phone:810-648-8000
Mailing Address - Fax:810-648-9887
Practice Address - Street 1:454 W SANILAC RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1065
Practice Address - Country:US
Practice Address - Phone:810-648-8000
Practice Address - Fax:810-648-9887
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor