Provider Demographics
NPI:1043252349
Name:GLADDEN HUNTER CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:GLADDEN HUNTER CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-520-2929
Mailing Address - Street 1:990 ENCHANTED WAY
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0915
Mailing Address - Country:US
Mailing Address - Phone:805-520-2929
Mailing Address - Fax:
Practice Address - Street 1:990 ENCHANTED WAY
Practice Address - Street 2:SUITE 101A
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0915
Practice Address - Country:US
Practice Address - Phone:805-520-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27915111N00000X
CA25341111N00000X
CA30034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGL ZZZ66532ZOtherBLUE SHIELD PHYSICAL
CAZZZ66531ZOtherBLUE SHIELD CHIRO