Provider Demographics
NPI:1497780175
Name:GLOCHESKI, JOHN GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GARY
Last Name:GLOCHESKI
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 1:8635 REDWATER DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4950
Mailing Address - Country:US
Mailing Address - Phone:916-725-7290
Mailing Address - Fax:
Practice Address - Street 1:6428 WATT AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-3612
Practice Address - Country:US
Practice Address - Phone:916-331-6960
Practice Address - Fax:916-331-3228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0223470Medicare ID - Type Unspecified