Healthcare Provider Details

I. General information

NPI: 1821602715
Provider Name (Legal Business Name): SHEITELMAN MEDICAL GLENDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5128 W PEORIA AVE
GLENDALE AZ
85302-1618
US

IV. Provider business mailing address

5128 W PEORIA AVE
GLENDALE AZ
85302-1618
US

V. Phone/Fax

Practice location:
  • Phone: 623-214-7600
  • Fax: 623-614-7662
Mailing address:
  • Phone: 623-214-7600
  • Fax: 623-614-7662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID SHEITELMAN
Title or Position: OWNER
Credential: DC
Phone: 623-214-7600