Provider Demographics
NPI:1932521895
Name:GLASS, BEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:GLASS
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 1:224 E 15TH ST
Mailing Address - Street 2:APT.207
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 8TH STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:510-606-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor