Provider Demographics
NPI:1023133139
Name:MICHEELS, GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:MICHEELS
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 1:8923 W DALEY LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1938
Mailing Address - Country:US
Mailing Address - Phone:602-301-3013
Mailing Address - Fax:602-843-3787
Practice Address - Street 1:17224 N 43RD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4025
Practice Address - Country:US
Practice Address - Phone:602-301-3013
Practice Address - Fax:602-843-3787
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5567111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC5567Medicare ID - Type Unspecified