| Entity Name: | GLEN SIEGEL, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Aug 1982 (42 years ago) |
| Document Number: | F95381 |
| FEI/EIN Number | 592213277 |
| Address: | % DR. GLEN SIEGEL, 7942 PINES BLVD, PEMBROKE PINES, FL, 33024 |
| Mail Address: | % DR. GLEN SIEGEL, 7942 PINES BLVD, PEMBROKE PINES, FL, 33024 |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861813511 | 2013-12-26 | 2013-12-26 | 7942 PINES BLVD, PEMBROKE PINES, FL, 330246908, US | 7942 PINES BLVD, PEMBROKE PINES, FL, 330246908, US | |||||||||||||||||||||||||
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| Phone | +1 954-966-8770 |
| Fax | 9543671226 |
Authorized person
| Name | DR. GLEN SIEGEL |
| Role | OWNER |
| Phone | 9549668770 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0002753 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051178100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SIEGEL, DR. GLEN | Agent | 7942 PINES BLVD, PEMBROKE PINES, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| Siegel Glen | President | % DR. GLEN SIEGEL, PEMBROKE PINES, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| Siegel Glen | Director | % DR. GLEN SIEGEL, PEMBROKE PINES, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| Siegel Rhonda | Owne | % DR. GLEN SIEGEL, PEMBROKE PINES, FL, 33024 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
