Provider Demographics
NPI:1881660629
Name:GLASSMAN, DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:GLASSMAN
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 1:8617 W UNION HILLS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7001
Mailing Address - Country:US
Mailing Address - Phone:623-979-2263
Mailing Address - Fax:623-334-5095
Practice Address - Street 1:8617 W UNION HILLS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7001
Practice Address - Country:US
Practice Address - Phone:623-979-2263
Practice Address - Fax:623-334-5095
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ986111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0081000OtherBLUE CROSS BLUE SHIELD
AZT41647Medicare UPIN
AZZ$$$$$$$$$Medicare PIN