Provider Demographics
NPI:1336276468
Name:GLOWAKI, BRADLEY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:GLOWAKI
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 1:1500 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6249
Mailing Address - Country:US
Mailing Address - Phone:562-596-9854
Mailing Address - Fax:562-596-9834
Practice Address - Street 1:1500 PACIFIC COAST HWY
Practice Address - Street 2:SUITE A
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6249
Practice Address - Country:US
Practice Address - Phone:562-596-9854
Practice Address - Fax:562-596-9834
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor