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NPI Code Detail

MEDICARE: GLEN JUKES D.C.

MEDICARE: GLEN JUKES D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorDC30958CA

General Provider Information

NPI Number : 1417194481
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLEN JUKES D.C.
Provider Business Mailing Address
First Line : 21408 VENTURA BLVD
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-2008
Country : US
Telephone Number : 818-887-8244
Fax Number :
Provider Business Practice Location Address
First Line : 21408 VENTURA BLVD
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-2008
Country : US
Telephone Number : 818-887-8244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2009
Last Update Date : 10/31/2011

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Directions to “ GLEN JUKES D.C.” Practice Location

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