Provider Demographics
NPI:1831311521
Name:GLASS CHIROPRACTIC CLINIC PS
Entity Type:Organization
Organization Name:GLASS CHIROPRACTIC CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-484-2044
Mailing Address - Street 1:4407 N DIVISION ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1600
Mailing Address - Country:US
Mailing Address - Phone:509-484-2044
Mailing Address - Fax:509-489-6733
Practice Address - Street 1:4407 N DIVISION ST
Practice Address - Street 2:SUITE 415
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1600
Practice Address - Country:US
Practice Address - Phone:509-484-2044
Practice Address - Fax:509-489-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
663230OtherAETNA
GL7135OtherASURIS
WA104845OtherL&I
663230OtherAETNA
GAB26057Medicare PIN