Provider Demographics
NPI:1891866554
Name:GLANDORF CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:GLANDORF CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLANDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-667-6831
Mailing Address - Street 1:1111 W TOWN AND COUNTRY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4615
Mailing Address - Country:US
Mailing Address - Phone:714-667-6831
Mailing Address - Fax:714-569-0463
Practice Address - Street 1:1111 W TOWN AND COUNTRY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4615
Practice Address - Country:US
Practice Address - Phone:714-667-6831
Practice Address - Fax:714-569-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT95748Medicare UPIN
CADC19467Medicare PIN