MEDICARE: HEALTHSOURCE OF CENTRAL GLENDALE, P.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
1	111N00000X	Chiropractor	7663	AZ

General Provider Information

NPI Number	:	1942384722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSOURCE OF CENTRAL GLENDALE, P.C.

Provider Business Mailing Address
First Line	:	5128 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1618
Country	:	US
Telephone Number	:	623-878-0600
Fax Number	:	623-878-6278

Provider Business Practice Location Address
First Line	:	5128 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1618
Country	:	US
Telephone Number	:	623-878-0600
Fax Number	:	623-878-6278

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL J MASSOFF
Credential	:	CHIROPRACTOR
Telephone Number	:	623-878-0600

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/04/2012

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