Provider Demographics
NPI:1033242102
Name:GLASER, MAURICIO (DC)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:
Last Name:GLASER
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:PO BOX 941188
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31141-0188
Mailing Address - Country:US
Mailing Address - Phone:678-701-2225
Mailing Address - Fax:678-701-2226
Practice Address - Street 1:3571 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4409
Practice Address - Country:US
Practice Address - Phone:678-701-2225
Practice Address - Fax:678-701-2226
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8643111N00000X
GACHRI007588111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation