Provider Demographics
NPI:1174503072
Name:NORTH GLEN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NORTH GLEN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NASON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-247-4766
Mailing Address - Street 1:5612 SPA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2025
Mailing Address - Country:US
Mailing Address - Phone:323-513-2983
Mailing Address - Fax:
Practice Address - Street 1:3542 HOLLYDALE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2117
Practice Address - Country:US
Practice Address - Phone:818-247-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20329Medicare ID - Type Unspecified
U09632Medicare UPIN