Provider Demographics
NPI:1760402028
Name:GLAZER, SHELBY ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:ROSS
Last Name:GLAZER
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 1:24725 W 12 MILE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1801
Mailing Address - Country:US
Mailing Address - Phone:248-353-2225
Mailing Address - Fax:248-353-2239
Practice Address - Street 1:24725 W 12 MILE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1801
Practice Address - Country:US
Practice Address - Phone:248-353-2225
Practice Address - Fax:248-353-2239
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISG007367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M54070Medicare ID - Type Unspecified
MIU68139Medicare UPIN