Provider Demographics
NPI:1164454245
Name:GLOEKLER, NORMAN J (DC)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:J
Last Name:GLOEKLER
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 1:4239 LAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6844
Mailing Address - Country:US
Mailing Address - Phone:440-992-3112
Mailing Address - Fax:440-992-1139
Practice Address - Street 1:4239 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6844
Practice Address - Country:US
Practice Address - Phone:440-992-3112
Practice Address - Fax:440-992-1139
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000131102OtherANTHEM
OH0444353Medicaid
OH73735293001OtherCIGNA
OH792350266OtherMC RROAD
OH0444353Medicaid
OHT47224Medicare UPIN