Provider Demographics
NPI:1740338128
Name:GLENN S CLOUD, DC
Entity type:Organization
Organization Name:GLENN S CLOUD, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC CHIROPRACTOR
Authorized Official - Phone:562-691-2225
Mailing Address - Street 1:417 W LA HABRA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631
Mailing Address - Country:US
Mailing Address - Phone:562-691-2225
Mailing Address - Fax:562-691-9725
Practice Address - Street 1:417 W LA HABRA BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631
Practice Address - Country:US
Practice Address - Phone:562-691-2225
Practice Address - Fax:562-691-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0143400OtherBLUE CROSS
CAW20760Medicare PIN