Provider Demographics
NPI:1659498095
Name:MCGLAUCHLIN, CAROL (DOM)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:MCGLAUCHLIN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5300 SEQUOIA RD NW
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1284
Mailing Address - Country:US
Mailing Address - Phone:505-550-8148
Mailing Address - Fax:505-255-7201
Practice Address - Street 1:5300 SEQUOIA RD NW
Practice Address - Street 2:SUITE 206
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1284
Practice Address - Country:US
Practice Address - Phone:505-550-8148
Practice Address - Fax:505-255-7201
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM908171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist