Provider Demographics
NPI:1518979467
Name:LAY, WILLIAM GLENN (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GLENN
Last Name:LAY
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 1:17731 N MILLER WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-6920
Mailing Address - Country:US
Mailing Address - Phone:520-245-3661
Mailing Address - Fax:
Practice Address - Street 1:17731 N MILLER WAY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-6920
Practice Address - Country:US
Practice Address - Phone:520-245-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4006111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ74857Medicare PIN