Provider Demographics
NPI:1801081575
Name:GLASCO CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:GLASCO CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:GLASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-691-8775
Mailing Address - Street 1:11639 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5802
Mailing Address - Country:US
Mailing Address - Phone:405-691-8775
Mailing Address - Fax:405-691-8957
Practice Address - Street 1:11639 S. WESTERN AVE.
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170
Practice Address - Country:US
Practice Address - Phone:405-691-8775
Practice Address - Fax:405-691-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU78270Medicare UPIN