Provider Demographics
NPI:1346648979
Name:GLENDALE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:GLENDALE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-771-1109
Mailing Address - Street 1:1125 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4426
Mailing Address - Country:US
Mailing Address - Phone:513-771-1109
Mailing Address - Fax:513-771-1129
Practice Address - Street 1:1125 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-4426
Practice Address - Country:US
Practice Address - Phone:513-771-1109
Practice Address - Fax:513-771-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-13
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty