Provider Demographics
NPI:1477714368
Name:GLUKHOVSKY, PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:GLUKHOVSKY
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 1:1428 N WATERMAN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5382
Mailing Address - Country:US
Mailing Address - Phone:909-383-4201
Mailing Address - Fax:909-383-4281
Practice Address - Street 1:1428 N WATERMAN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5382
Practice Address - Country:US
Practice Address - Phone:909-383-4201
Practice Address - Fax:909-383-4281
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor