Provider Demographics
NPI:1689690323
Name:GLUSAC, PETER D
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:GLUSAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:519 W CARSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2642
Mailing Address - Country:US
Mailing Address - Phone:310-533-1070
Mailing Address - Fax:
Practice Address - Street 1:519 W CARSON ST STE 101
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2642
Practice Address - Country:US
Practice Address - Phone:310-533-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor