Provider Demographics
NPI:1093887614
Name:CAUBLE, GLEN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:ROBERT
Last Name:CAUBLE
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 1:8586 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3131
Mailing Address - Country:US
Mailing Address - Phone:714-841-4300
Mailing Address - Fax:714-848-1226
Practice Address - Street 1:8586 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3131
Practice Address - Country:US
Practice Address - Phone:714-841-4300
Practice Address - Fax:714-848-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA73-1680212OtherFEDERAL TAX ID NUMBER
CA73-1680212OtherFEDERAL TAX ID NUMBER