Provider Demographics
NPI:1942528385
Name:GLENDALE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:GLENDALE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-945-0008
Mailing Address - Street 1:4432 N MILLER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3697
Mailing Address - Country:US
Mailing Address - Phone:480-945-0008
Mailing Address - Fax:480-945-2778
Practice Address - Street 1:9971 W CAMELBACK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5011
Practice Address - Country:US
Practice Address - Phone:623-872-0002
Practice Address - Fax:623-872-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty