Provider Demographics
NPI:1972600013
Name:GLADER, JEFF ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:ALAN
Last Name:GLADER
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 1:3333 S WADSWORTH BLVD UNIT D319
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5165
Mailing Address - Country:US
Mailing Address - Phone:303-936-4890
Mailing Address - Fax:303-795-9248
Practice Address - Street 1:3333 S WADSWORTH BLVD UNIT D319
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5165
Practice Address - Country:US
Practice Address - Phone:303-936-4890
Practice Address - Fax:303-795-9248
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC18213Medicare ID - Type Unspecified